A Closer Look at Outcomes of Patients with Alcohol Use Disorders Who Are Hospitalized with Pneumonia

While it has been a long-standing belief that patients with alcohol use disorder (AUD) have a higher risk of developing pneumonia due to resistant gram-negative organisms, a recent study showed very different results. The goal of the study was to compare pneumonia in patients with and without AUD and to understand the effects of alcohol on patient outcomes.

More than 137,000 adult patients with pneumonia admitted to 177 U.S. hospitals were entered into a database from 2010 to 2015. Researchers looked at the cause of pneumonia, the antibiotic treatment, clinical deterioration, mortality in the hospital, length of stay and costs.

Michael B. Rothberg, MD, Vice Chair of Research in Cleveland Clinic’s Medicine Institute, was the corresponding author on this study, working alongside other Cleveland Clinic researchers from the Lerner Research Institute and the University of Massachusetts Medical School.

In this retrospective cohort study, researchers were surprised to learn that alcohol use does not predispose people to gram-negative pneumonia. Although guidelines from the Infectious Disease Society of America identify alcohol use as a risk factor for resistant gram-negative organisms (including Klebsiella), in this study, patients with AUD less frequently grew organisms resistant to guideline-recommended antibiotics for community-acquired pneumonia (CAP).

“As a result of this, our team concluded that, in the absence of other risk factors for resistant organisms, patients with AUD should be treated with first line antibiotics, such as a third generation cephalosporin plus a macrolide,” Dr. Rothberg says. “The other interesting finding was that patients with AUD had higher age-adjusted mortality, but that was completely attributable to co-morbidities.”

However, he notes the study found that co-morbidities alone could not explain why patients with AUD had longer lengths of stay and were more likely to require intensive care. These findings appeared to be the result of alcohol withdrawal (AWD), prompting the authors to conclude that treatment for CAP and AUD should include close monitoring for AWD.

Of the study participants with CAP, 3.5% were identified to have AUD, and these patients were younger (median age 58 vs 73 in the overall study) and had more of certain co-morbid conditions, including chronic liver disease, smoking and malnutrition. Compared to patients without AUD, they were less likely to receive a principal diagnosis of pneumonia, and more likely to have aspiration pneumonia, sepsis or respiratory failure. Patients experiencing AWD had poorer outcomes in the AUD group.

In summary, study results suggested that AUD alone is not a risk factor for mortality or resistant infection, however alcohol withdrawal is correlated with a higher use of healthcare resources and clinical decline.

In general, the researchers noted that CAP is the sixth leading cause of death in the U.S. and the most common cause of mortality for people with infectious disease.1 And AUD affects 15.1 million2 U.S. adults and around 4% of patients who are hospitalized with pneumonia.3

References

1. Niederman MS, Mandell LA, Anzueto A, et al; American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001;163(7):1730-1754.

2. National Institute on Alcohol Abuse and Alcoholism. Alcohol facts and statistics. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics. Updated August 2018. Accessed March 26, 2018.

3. Saitz R, GhaliWA, Moskowitz MA. The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med. 1997;157(13):1446-1452.