Resistant Organisms in Community-Acquired Pneumonia With or Without Alcohol Use Disorders

Hospitalized patients with community-acquired pneumonia (CAP) and alcohol use disorder (AUD) harbor resistant organisms less frequently than patients without AUD, according to retrospective study results published in JAMA Network Open.  

Investigators sought to compare the causes, treatment, and outcomes in patients with CAP with and without AUD, as well as to understand the relationships of comorbid illnesses, alcohol withdrawal syndrome (AWS), and any residual effects of alcohol itself with patient outcomes. A total of 137,496 adults age ≥18 with CAP admitted to a US hospital between July 1, 2010 and June 30, 2015 were evaluated. The main study outcomes included cause of pneumonia, antibiotic therapy, length of hospital stay, inpatient mortality, clinical deterioration, and cost, along with the association of AUD with these variables.

Overall, 70,358 of the participants were women and 67,138 were men. The mean patient age was 69.5±16.2; 3.5% of the patients had an AUD. Patients with an AUD compared with patients without an AUD were significantly younger (median age, 58 vs 73, respectively; P <.001); were more often men (77.3% vs 47.8%, respectively; P <.001); and more often had a principal diagnosis of sepsis (38.6% vs 30.7%, respectively; P <.001), aspiration pneumonia (10.9% vs 9.8%, respectively; P <.001), or respiratory failure (9.3% vs 5.5%, respectively; P <.001).

In addition, the cultures of participants with AUD vs participants without AUD more frequently grew Streptococcus pneumoniae (43.7% vs 25.5%, respectively; P <.001) and less often grew organisms resistant to guideline-recommended antibiotics (25.0% vs 43.7%, respectively; P <.001). Moreover, patients with AUD compared with patients without AUD were significantly more often treated with piperacillin-tazobactam (26.2% vs 22.5%, respectively; P <.001) but equally as often treated with anti–methicillin-resistant Staphylococcus aureus agents (32.9% vs 31.8%, respectively; P =.11).

Following adjustment for demographic characteristics and insurance, AUD was associated with higher mortality (odds ratio, 1.40; 95% CI, 1.25-1.56), length of hospital stay (risk-adjusted geometric mean ratio, 1.24; 95% CI, 1.20-1.27), and costs (risk-adjusted geometric mean ratio, 1.33; 95% CI, 1.28-1.38).

Models that segregated patients who were undergoing alcohol withdrawal demonstrated that poorer outcomes in patients with AUD were limited to the subgroup of patients experiencing AWS.

The investigators concluded that patients with AUD, who totaled 1 in 30 patients hospitalized with CAP, had age-adjusted outcomes that were poorer than those of the patients with CAP without AUD. This finding is based on the presence of excess comorbidities, including chronic liver disease, malnutrition, and smoking, in patients with AUD. Treatment of patients with AUD should include routine CAP therapy and close monitoring for AWS.

Reference

Gupta NM, Lindenauer PK, Yu PC, et al. Association between alcohol use disorders and outcomes of patients hospitalized with community-acquired pneumonia. JAMA Netw Open. 2019;2(6):e195172.

This article originally appeared on Pulmonology Advisor