Advertisement

The Epidemiology of Alcohol Abuse and Pneumonia

  • Kyle I. HappelEmail author
Chapter
Part of the Respiratory Medicine book series (RM, volume 14)

Abstract

The association between alcohol abuse and pneumonia has been recognized for more than two centuries and represents an enormous health burden worldwide. The first published notation of alcohol as a clinical risk factor for the development of pneumonia is now over 200 years old, and since then there have been over a 1,000 references in the medical literature confirming these observations. Even in this modern era of medicine pneumonia remains a common infection that afflicts over 450 million persons worldwide annually and causes 7 % of all deaths. When one considers that alcohol is the most commonly abused substance in the world, the enormous excessive burden that alcohol contributes to the morbidity and mortality of pneumonia represents a major public health consideration. In this chapter we review the foundational literature that has chronicled the evolution of our understanding of the association between pneumonia and alcohol abuse over the past century. In addition, we discuss some of the specific pathogens that are particularly associated with serious lung infections in individuals with alcohol use disorders. Finally, we consider some of the specific guidelines for the treatment and prevention of pneumonia in the setting of alcohol abuse.

Keywords

Alcohol abuse Pneumonia Risk factor Pneumococcus Anaerobic pathogens Haemophilus influenzae Klebsiella pneumoniae Pseudomonas aeruginosa 

A Historical Perspective on Alcohol Abuse and Pneumonia

Most reviews on alcohol abuse and pneumonia credit Benjamin Rush, the first Surgeon General of the USA, as one of the earliest clinicians to recognize tuberculosis and pneumonia as infectious sequelae of excessive drinking, as was elaborated in his 1785 work entitled “An Inquiry Into the Effects of Ardent Spirits Upon the Human Body and Mind” [1]. This work also laid the foundation for the description of alcoholism as a disease rather than just a behavior as was the prevailing attitude at the time. Further credence to the association of alcohol abuse and pneumonia came in 1895 when Sir William Osler, often called the “Father of Modern Medicine,” also advocated that excessive alcohol intake was a potent predisposing factor in the development of lobar pneumonia [2]. Interestingly, and quite ironically, at that time there were those who extolled the therapeutic use of alcohol as a treatment for pneumonia, particularly in cases with severe systemic manifestations. In his 1912 article, A.T. Jones of the London Royal College of Physicians describes his abandonment of therapeutic alcohol in cases of lobar pneumonia, after which his case mortality rate fell dramatically from 38 to 18 % after omitting alcohol as a component of his treatment regimen [3]. This experience led him to conclude that alcohol was expensive and of very little help, if any, in treating pneumonia and therefore that a patient’s money would be likely better spent on nutrients to secure their recovery. Shortly thereafter in 1923 came a somewhat more robust description of case mortality rates observed in 3,422 patients admitted to Cook County Hospital for pneumonia from 1911 to 1922. In this work, Capps and Coleman showed both a stepwise increase in the incidence of lobar pneumonia, as well as greater case mortality rates (22, 34, or 50 %) in patients who were essentially abstainers, moderate, or heavy drinkers, respectively [4]. Even when their subjects were stratified for age, substantial differences in fatality results remained with a nearly 70 % mortality rate in heavy drinkers over the age of 60. These observations were supported by subsequent studies that associated alcohol abuse with twofold to threefold increased mortality rates from pneumonia [5, 6]. These dramatic clinical observations of an association between alcohol abuse and pneumonia prompted Branch and Stillman to perform landmark experimental studies, published in a series of papers beginning in 1924, in which they demonstrated that acute alcohol administration in mice caused septicemia and death following pneumococcal aerosolization [7]. These provocative studies in the so-called “pre-antibiotic era” identified a clear and independent mechanistic association between alcohol abuse and pneumonia and laid the foundation for intensive investigations on the part of clinical and basic science researchers that continue to this day. Unfortunately, although these research efforts have elucidated the clinical features and underlying pathophysiologic mechanisms, the devastating impact of alcohol abuse and pneumonia on our society remains as problematic as when the association was first chronicled.

Alcohol Abuse: A Persistent Risk Factor for Pneumonia in the Age of Antibiotics

While modern medicine is characterized by several notable milestone achievements, in the context of the study of infectious diseases perhaps none is greater than the serendipitous discovery of penicillin by Alexander Fleming in 1928 [8]. Subsequent large-scale synthesis of the drug for the war effort saved the lives of many allied soldiers in World War II, and soon thereafter this wonder drug found widespread civilian application as an effective antimicrobial treatment against most pathogens causing bacterial pneumonia. As a result, pre-antibiotic pneumonia mortality rates within the US population, previously estimated at 200 deaths per 100,000, plummeted to 31 per 100,000 by 1949 [9]. In parallel, rates of serious complications such as empyema also declined precipitously [10, 11, 12]. Despite these initial and subsequent advances in antibiotic therapies, alcohol abuse as a significant risk factor for pneumonia continued. For example, in a large series of alcoholics in Canada who sought treatment for their addiction, investigators identified a threefold and sevenfold increase in pneumonia death rates in female and male drinkers, respectively, when compared to nonalcoholics with pneumonia [13]. A US study performed at that same time showed that alcoholism was an underlying condition in 35 % of hospitalized pneumonia cases [14]. Further, in a prospective series of 900 admissions to Yale’s Grace-New Haven Hospital, Nolan prospectively identified alcoholics as having three times the rate of hospitalization for pneumonia as nondrinkers, and nearly three quarters of alcoholics studied were admitted to the hospital for reasons considered directly attributable to their drinking [15]. In another well-performed study of enlisted US Navy personnel, Kolb demonstrated a doubling of the hospital admission rate for pneumonia in a cohort of 2,191 sailors who met criteria for alcohol abuse [16]. Further complicating matters, alcohol abusers are also at increased risk for developing recurrent pneumonia, as reflected by the observation that 40 % of patients with recurrent infection in one series had no other predisposing condition besides alcoholism [17]. Examining middle-aged adults in a case–control fashion, Fernandez-Sola found excessive alcohol intake as the only independent risk factor for community acquired pneumonia (CAP), and alcoholics had more severe symptoms, more multi-lobar involvement and parapneumonic effusions, and greater mortality than their nonalcoholic counterparts [18]. Even now as we are well into the twenty-first century, excessive alcohol consumption remains as an independent risk factor for the development of CAP and other serious lung infections [19, 20, 21, 22, 23], and the specific microbial pathogens that are overrepresented in these vulnerable individuals will be discussed next.

The Pneumococcus

When Osler characterized pneumonia as “the captain of the men of death”, it was undoubtedly due in large part to the intrinsic respiratory tract virulence of Streptococcus pneumoniae [24]. Since then, the majority of CAP series in which a specific etiologic agent could be identified have demonstrated that S. pneumoniae continues to be the most common pathogen, and this remains true as well in the subset of individuals with alcohol abuse [20, 22, 23, 25, 26, 27, 28, 29, 30, 31]. Even in the modern era of antibiotics and an effective vaccine, the overall case mortality rate for pneumococcal CAP in most recent series ranges from 10 to 30 % [32, 33, 34, 35, 36]. However, the independent effects of alcohol abuse on mortality in individuals hospitalized for pneumococcal CAP is difficult to quantify. As previously discussed, many historical studies have shown that alcohol abuse increases the risk of CAP mortality [4, 5, 6]. Consistent with this, a more recent Spanish study identified high alcohol intake as a risk factor for CAP mortality; however, pneumococcus was not a frequently isolated pathogen in that population [18]. Further, although the study of CAP in 2004 concluded that alcohol abuse was associated with increased mortality in a univariate analysis, this association was lost in the multivariate analysis [37]. Similarly, De Roux and colleagues studied a large cohort of individuals hospitalized for CAP (the majority of whom had S. pneumoniae infection) and found that despite a strong association between current or previous alcohol abuse and pneumococcal pneumonia, mortality in current alcoholics was not different than in nondrinkers [38]. This finding of equivalent in-hospital pneumonia mortality in alcoholics and nonalcoholics has also been reported in other recent CAP cohorts [25, 39, 40]. These apparently conflicting results on the effect of alcohol abuse on CAP mortality are at face value confounding. However, a possible explanation for these discrepancies can be found in the results of a recent study by Goss and colleagues. Specifically, they determined that in a cohort of hospitalized low-risk CAP patients who could have otherwise been treated as outpatients, 49 % of them were alcoholics, 44 % of them were homeless, and 20 % of them were acutely intoxicated on presentation [41]. Therefore, individuals with underlying active alcohol use disorders may be admitted to the hospital for treatment for reasons unrelated to the severity of their pneumonia. If so, this could decrease their overall observed hospital mortality by including many individuals with a lower pneumonia-specific severity of illness as compared to the nonalcoholic subjects in the studies.

What appears less controversial is the increased risk for developing invasive (i.e., bacteremic) pneumococcal pneumonia in alcoholics. Using 1999 and 2000 data, the Centers for Disease Control (CDC) estimated that pneumococcal bacteremia occurs ten times more often in alcoholics compared to otherwise healthy adults [42]. Approximately 20–25 % of pneumococcal pneumonia cases are associated with bacteremia [21, 43], and mortality rates for bacteremic pneumonia are generally somewhat higher than in non-bacteremic disease [44, 45]. In a prospective series of 100 cases of proven pneumococcal pneumonia, alcohol abuse was the only demographic risk factor predictive of bacteremia [33]. Indeed, results from multiple studies in separate cohorts have consistently demonstrated clear and convincing evidence of a heightened risk for invasive pneumococcal disease, including bacteremic pneumococcal pneumonia, in alcohol abusers [25, 46, 47, 48, 49, 50, 51, 52], and alcoholics are four times more likely to die from bacteremic pneumococcal pneumonia than nonalcoholics [53]. A particularly poor outcome is seen in alcoholics with bacteremic pneumococcal pneumonia, sepsis, and leukopenia in whom mortality exceeded 80 % [54]. This series led to the coining of the term “Alcoholic Leukopenic Pneumococcal Sepsis Syndrome” or ALPS Syndrome. Many of these patients developed a severe form of lung injury known as the acute respiratory distress syndrome (ARDS), and a subsequent chapter in this book discusses in detail the more recently identified association between alcohol abuse and ARDS in critically ill individuals [55].

An unavoidable consequence of the widespread use of antibiotics is the eventual selection of resistant pathogens, and drug-resistant S. pneumoniae (DRSP) is now prevalent in several countries [56]. In the joint American Thoracic Society and Infectious Diseases Society of America CAP guidelines published in 2007, alcoholism is cited as a risk factor for infection with S. pneumoniae resistant to beta-lactam antibiotics [22]. A study published subsequent to these guidelines found a fivefold increased risk for DRSP infection in alcohol abusers [57], although other studies have not found such a significant association [38, 58].

Anaerobic Pathogens

Commensal anaerobes make up the dominant microbial population of the oropharynx [59] and although not particularly virulent, these pathogens are quite capable of causing pneumonia if they are aspirated into the lower airways. As a direct result of impaired consciousness and depressed cough reflex, alcohol intoxication facilitates the aspiration of substantial amounts of oropharyngeal secretions in which colonizing bacteria (commensal or otherwise) gain access to the usually sterile lower airways where they can cause pneumonia [60, 61]. Dominant pathogens in anaerobic pneumonia include Peptostreptococcus, Bacteroides, Prevotella, and Fusobacterium species, although mixed flora, including gram negative rods, are increasingly recognized participants [62, 63, 64]. Due to significant exotoxin production by anaerobic bacteria, many cases evolve into a necrotizing pneumonia or lung abscess, with or without frank empyema formation [29]. Case series of anaerobic pleuropulmonary disease have suggested that up to 70 % of cases are associated with alcohol abuse [65, 66, 67, 68, 69, 70]. Fortunately, the mortality rates from these infections have dropped considerably (from 34 to 5 %) since the introduction of antibiotics, and, equally fortunately, at least to date the pathogens causing anaerobic pleuropulmonary disease generally remain antibiotic-susceptible [71].

Haemophilus influenzae

A moderate amount of evidence supports the conclusion that alcohol abuse also increases the risk of pneumonia caused by H. influenzae. Several studies in the mid- to late twentieth century described a high prevalence (up to 50 %) of alcohol abuse in cases of H. influenzae pneumonia [72, 73, 74, 75], although there is some suggestion that alcoholic liver disease must also be present for there to be a significantly increased susceptibility to this pathogen [76]. It is not clear which capsular subtypes and/or or untypeable strains are responsible for these pneumonias in alcohol abusers, and therefore at least at this time the current CDC recommendations do not include alcoholism per se as an indication for routine H. influenzae B vaccination in adults [77].

Klebsiella pneumoniae

Initially described in the nineteenth century as by Friedlander and therefore known as “Friedlander’s bacillus”, this highly virulent gram negative rod is often found in the pharyngeal flora of alcoholics [78] and is a deadly respiratory pathogen that is often identified as the etiology of pneumonia in these susceptible individuals [14, 79, 80, 81, 82, 83]. Early studies noted the majority of patients with Klebsiella infection were alcoholic, many of whom produced a characteristically thick and bloody sputum that was often referred to as “currant jelly sputum” that was believed to consist of necrotic lung, hemorrhage, and the bacteria’s mucoid capsule. Highlighting the prognostic value of the blood leukocyte count in such cases, in 1956 Limson described a series of 22 individuals with K. pneumoniae lung infection in whom all of those who were alcoholic and had a low or even normal circulating leukocyte count succumbed to their acute disease [84]. More recent studies continue to show an association between Klebsiella pneumonia and alcohol abuse including excessive rates of bacteremia and death despite aggressive antibiotic therapy and supportive management in the intensive care unit [18, 85, 86, 87, 88, 89]. Many of these recent (and some older) studies attest to the antibiotic resistance of this pathogen, and this challenge of antibiotic resistance has worsened in recent years [90]. Some experts now consider K. pneumoniae as the prototypical organisms to express extended spectrum beta lactamase (ESBL) activity [91], and more recently some K. pneumoniae isolates from several countries have even been found to express carbapenemase, thereby rendering them resistant to one of the most effective gram-negative antibiotic classes [92]. Therefore, clinicians caring for individuals with underlying alcohol use disorders presenting with pneumonia, particularly those who are severely ill, need to consider these factors carefully in selecting appropriate therapy.

Pseudomonas aeruginosa and Acinetobacter Species

Although not commonly considered community-acquired lung infections, pneumonias caused by virulent gram negative pathogens such as P. aeruginosa and Acinetobacter species nevertheless do occur and carry excess morbidity and mortality [22]. In a study of individuals with severe CAP, Marik found that infection with these pathogens imposed a very high mortality (82 %), and the only clinical factor that appeared to increase the risk of infection with these microbes was a history of alcohol abuse [93]. Subsequent work in Taiwan found that alcoholism frequently accompanied severe CAP caused by Acinetobacter baumanii [94], and it is concerning that this association was seen in relatively younger individuals. A recent and comprehensive summary of community-acquired Acinetobacter infections consistently identified alcohol abuse as a risk factor in the majority of case series [95]. In developed countries, pneumonia caused by these pathogens is more commonly associated with a nosocomial infection (i.e., acquired in the hospital) and usually in the context of a critically ill individual receiving mechanical ventilation. In this setting, individuals with underlying alcohol abuse experience increased rates of pneumonia with these and other drug-resistant pathogens, and they are more likely to succumb to infection than are their nonalcoholic counterparts [96, 97, 98, 99, 100, 101]. As those who abuse alcohol are ostensibly forced to suspend their drinking while they are hospitalized, many develop an acute alcohol withdrawal syndrome. To complicate matters further, the occurrence of this acute withdrawal syndrome increases the risk of nosocomial pneumonia [97, 100], and the development of pneumonia in this setting is a strong predictor of increased hospital mortality [101]. Additional discussion of the care for hospitalized alcoholics can be found in a subsequent chapter ( Chap. 14).

Mycobacterium tuberculosis

Just as long-recognized as the association between alcohol abuse and bacterial pneumonia is the increased incidence of pulmonary tuberculosis in the alcoholic patient [1]. Although also a bacterial pathogen, the acquisition of pulmonary tuberculosis is quite different than that of other “typical” bacterial pneumonias. While most cases of bacterial pneumonia are caused by the pulmonary aspiration of pathogen-colonized oropharyngeal secretions, M. tuberculosis inoculates the lung by direct inhalation of aerosolized organisms (as is true of Legionella, influenza, and other respiratory viruses) [102]. As a result, person-to-person spread is a major feature of tuberculosis not seen in most bacterial pneumonias, making it a major public health scourge over many centuries in which epidemics rise and fall over many decades within a discrete population. In this regard, an individual’s environment and community strongly influence the chance of being exposed to and contracting tuberculosis. Unfortunately, individuals with chronic alcohol use disorders are more likely to be homeless and to subsequently reside in dense cohorts (e.g., shelters, group homes, jails, and prisons), environments that are conducive to effective tuberculosis transmission [103, 104, 105]. This confounding effect has led some investigators to caution against a definitive conclusion regarding a causative effect of excessive alcohol intake on tuberculosis incidence [106, 107, 108], while others conclude that alcohol abuse does indeed confer increased susceptibility to this pathogen [109, 110, 111]. In support of a causal effect of alcohol abuse on pulmonary tuberculosis is a collective body of experimental evidence from animal studies showing that a multitude of pulmonary host defenses mechanisms against tuberculosis are adversely impacted by alcohol [112, 113, 114, 115]. For example, live infection with tuberculosis in a mouse model has shown that chronic alcohol feeding is associated with impaired pulmonary clearance of pathogen, a defect likely caused by reduced T cell responses and granuloma formation in the lung [115]. More recently, statistically robust international analyses of the association between alcohol use and tuberculosis conclude that alcohol abuse confers a nearly threefold increase in the relative risk for active tuberculosis infection [116, 117]. Equally concerning from a clinical perspective are the findings that active alcohol users exhibit altered pharmacokinetics of anti-tuberculous medicines, and, not surprisingly, are less compliant with their treatment regimen [108, 118]. The latter facet is likely a key determinant in the alarming findings that alcoholics are more likely to become reinfected with tuberculosis and are more likely to harbor a drug-resistant tuberculosis strain [119, 120, 121]. While the emergence of infection with the human immunodeficiency virus (HIV) is the overwhelming factor underlying the global resurgence of tuberculosis rates, it is nevertheless still currently estimated that 10 % of tuberculosis cases worldwide can be attributed to alcohol abuse [117]. A thorough discussion of the pulmonary sequelae of alcohol abuse and HIV infection is provided in a subsequent chapter ( Chap. 15).

Alcohol and Pneumonia: The Current Socioeconomic Burden

According to the 2010 National Survey on Drug Use and Health, 16.9 million Americans reported heavy alcohol use, representing 6.7 % of the US population over the age of 12 [122]. Globally, the World Health Organization estimates that 2.5 million persons die each year as a result of alcohol use [123], which represents 4 % of global deaths and reflects a greater impact than the number of deaths caused by HIV, violence, or tuberculosis. In fact, worldwide alcohol abuse is the third greatest risk factor for the development of disease and disability, and in upper middle income countries it is now the greatest risk factor, with Russia and the former Soviet Union countries exhibiting some of the highest alcohol-attributable death rates. Although the exact contribution of alcohol to current pneumonia incidence and death is difficult to determine, a recent and large meta-analysis by Samokhvalov demonstrated a dose–response curve to drinking and CAP incidence, with individuals clinically classified as having an alcohol use disorder exhibiting eight times the risk for CAP [124]. Given these findings and recent data indicating that pneumonia and influenza were the 8th leading cause of death in America in 2011 [125], it is clear that alcohol abuse remains a pertinent, pervasive, and potentially modifiable adverse health factor from a public health policy perspective.

The estimated total cost of excessive alcohol consumption in the USA alone in 2006 was over 200 billion dollars [126]. While only a part of this cost is direct healthcare utilization, this figure nevertheless reflects the considerable economic burden of alcohol abuse to our society. A study of pneumonia hospitalizations in Massachusetts found that cases associated with alcohol-related diagnoses had a longer length of stay, a 50 % greater intensive care unit utilization, and a significant increase in hospital charges—although mortality rates were similar (10 %) [127]. A more recent large cross-sectional study of Danish persons aged 50–64 revealed a nearly doubling of risk for pneumonia hospitalization in heavy drinkers, as defined by greater than 50 drinks per week [128]. Similar studies from European nations have also demonstrated a greater length of stay, increased ICU use, and increased need for mechanical ventilation in alcohol abusers with CAP [38, 39, 129, 130, 131]. A further contributor to the economic burden of pneumonia in alcoholics is the previously discussed need to hospitalize a greater proportion of these patients than would otherwise be warranted on the basis of their infection severity [41]. A similar picture has emerged in the context of hospital-acquired pneumonia; specifically, alcoholics are more likely to develop nosocomial pneumonia despite a lower overall illness acuity, and the cost to care for such events is substantial [98, 132]. Even after discharge from the hospital following a pneumonia admission, alcohol abusers are more likely to return to a primary care center or emergency department within 30 days of discharge [133].

Preventative measures against bacterial pneumonia in the individuals suffering from alcohol use disorders at present are essentially limited to addressing the alcohol consumption behavior itself and vaccination against infection, and more data are needed to assess the cost effectiveness of these expenditures in preventing pneumonia. Currently, the CDC Advisory Committee on Immunization Practices recommends pneumococcal and yearly influenza vaccination for all alcohol abusing persons [134, 135]. Unfortunately, in practice there appears to be less frequent vaccination against these pathogens in alcohol abusers, even in those with additional risk factors for pneumonia such as COPD or advanced age [136, 137, 138, 139]. This finding is quite disappointing, particularly as the available clinical data support the efficacy of the 23-valent polysaccharide pneumococcal vaccine in heavy drinkers, including those who are elderly [140, 141]. Whether the newer peptide-conjugate pneumococcal vaccine is of lesser, equal, or greater benefit in heavy alcohol users is yet to be determined, and therefore at the time this chapter was prepared its administration to this population is not currently recommended.

Summary

Alcohol abuse remains common throughout the world, and the medical literature is incontrovertible in its depiction of alcohol abuse as a risk factor for both an increased incidence and severity of bacterial pneumonia, whether acquired in the community or the hospital setting. The spectrum of pathogens causing pneumonia in the alcohol abuser is somewhat wider and more virulent than in non-abusers, such that the clinical history of alcohol abuse has a direct impact on the clinical care and outcome of such patients. In an era of spiraling global health care costs and regionally scarce health care resources, it would seem prudent to continue or even expand efforts to determine optimal prevention and treatment strategies for bacterial pneumonia and other sequelae of alcohol abuse in these persons. Such measures could have a significant effect not only on the outcome of disease for an individual, but also on the incidence of disease and alcohol’s overall economic burden to society. Although not discussed in this chapter, the association between alcohol and other health concerns such as HIV infection, tobacco use, and illicit substance use further supports comprehensive and robust research programs to identify and intervene in those alcohol abusing populations most amenable to response.

References

  1. 1.
    Rush B. An inquiry into the effects of ardent spirits upon the human body and mind. Q J Stud Alcohol. 1943;4:321–41.Google Scholar
  2. 2.
    Osler W. The principles and practice of medicine, vol. 1. New York: D. Appleton and Co.; 1895.Google Scholar
  3. 3.
    Jones AT. Statistics of a series of eighty-six cases of pneumonia, with a note on alcohol in the treatment. Br Med J. 1912;1(2673):667–8.PubMedGoogle Scholar
  4. 4.
    Capps JA, Coleman GH. Influence of alcohol on prognosis of pneumonia in Cook County hospital. JAMA. 1923;80(11):750–2.Google Scholar
  5. 5.
    Painton JF. Lobar pneumonia; an analysis of 1298 cases. Ann Int Med. 1937;10(9): 1345–64.Google Scholar
  6. 6.
    Sundby P. Alcoholism and mortality. Oslo, Norway: Universitetsforlaget; 1967.Google Scholar
  7. 7.
    Stillman EG, Branch A. Experimental production of pneumococcus pneumonia in mice by the inhalation method. J Exp Med. 1924;40(6):733–42.PubMedGoogle Scholar
  8. 8.
    Fleming A. On the antibacterial action of cultures of a penicillium with special reference to their use in the isolation of B. influenzae. Br J Exp Pathol. 1929;10(3):226–36.Google Scholar
  9. 9.
    Dowling HF. Frustration and foundation. Management of pneumonia before antibiotics. JAMA. 1972;220(10):1341–5.PubMedGoogle Scholar
  10. 10.
    Anderson T, Landsman JB. Oral penicillin in treatment of pneumonia in the adult. Br Med J. 1947;2(4536):950–3.PubMedGoogle Scholar
  11. 11.
    Collen MF. The treatment of pneumococcic pneumonia with penicillin and sulfadiazine. Calif Med. 1947;66(2):62–5.Google Scholar
  12. 12.
    Tillett WS, Cambier MJ, McCormack JE. The treatment of lobar pneumonia and pneumococcal empyema with penicillin. Bull N Y Acad Med. 1944;20(3):142–78.PubMedGoogle Scholar
  13. 13.
    Schmidt W, De Lint J. Causes of death of alcoholics. Q J Stud Alcohol. 1972;33(1):171–85.PubMedGoogle Scholar
  14. 14.
    Dorff GJ, Rytel MW, Farmer SG, Scanlon G. Etiologies and characteristic features of pneumonias in a municipal hospital. Am J Med Sci. 1973;266(5):349–58.PubMedGoogle Scholar
  15. 15.
    NOLAN JP. Alcohol as a factor in the illness of university service patients. Am J Med Sci. 1965;249:135–42.PubMedGoogle Scholar
  16. 16.
    Kolb D, Gunderson EK. A longitudinal study of health risks associated with alcohol abuse in young navy men. Drug Alcohol Depend. 1981;8(2):131–41.PubMedGoogle Scholar
  17. 17.
    Winterbauer RH, Bedon GA, Ball Jr WC. Recurrent pneumonia. Predisposing illness and clinical patterns in 158 patients. Ann Int Med. 1969;70(4):689–700.PubMedGoogle Scholar
  18. 18.
    Fernandez-Sola J, Junque A, Estruch R, Monforte R, Torres A, Urbano-Marquez A. High alcohol intake as a risk and prognostic factor for community-acquired pneumonia. Arch Int Med. 1995;155(15):1649–54.Google Scholar
  19. 19.
    Almirall J, Bolibar I, Serra-Prat M, Roig J, Hospital I, Carandell E, et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J. 2008;31(6):1274–84.PubMedGoogle Scholar
  20. 20.
    Herrero FS, Olivas JB. Microbiology and risk factors for community-acquired pneumonia. Semin Respir Crit Care Med. 2012;33(3):220–31.Google Scholar
  21. 21.
    Lynch 3rd JP, Zhanel GG. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention. Semin Respir Crit Care Med. 2009;30(2):189–209.PubMedGoogle Scholar
  22. 22.
    Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27–72.PubMedGoogle Scholar
  23. 23.
    Ruiz M, Ewig S, Torres A, Arancibia F, Marco F, Mensa J, et al. Severe community-acquired pneumonia. Risk factors and follow-up epidemiology. Am J Respir Crit Care Med. 1999; 160(3):923–9.PubMedGoogle Scholar
  24. 24.
    Osler W. Aequanimitas and other addresses to medical students, nurses and practitioners of medicine. London: H.K. Lewis; 1904.Google Scholar
  25. 25.
    Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999;160(2):397–405.PubMedGoogle Scholar
  26. 26.
    Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine. 1990;69(5):307–16.PubMedGoogle Scholar
  27. 27.
    Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med. 1995;333(24): 1618–24.PubMedGoogle Scholar
  28. 28.
    Sullivan Jr RJ, Dowdle WR, Marine WM, Hierholzer JC. Adult pneumonia in a general hospital. Etiology and host risk factors. Arch Int Med. 1972;129(6):935–42.Google Scholar
  29. 29.
    Adams HG, Jordan C. Infections in the alcoholic. Med Clin North Am. 1984;68(1):179–200.PubMedGoogle Scholar
  30. 30.
    Krumpe PE, Cummiskey JM, Lillington GA. Alcohol and the respiratory tract. Med Clin North Am. 1984;68(1):201–19.PubMedGoogle Scholar
  31. 31.
    MacGregor RR, Louria DB. Alcohol and infection. Curr Clin Top Infect Dis. 1997;17:291–315.PubMedGoogle Scholar
  32. 32.
    Kalin M, Ortqvist A, Almela M, Aufwerber E, Dwyer R, Henriques B, et al. Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries. J Infect Dis. 2000;182(3):840–7.PubMedGoogle Scholar
  33. 33.
    Musher DM, Alexandraki I, Graviss EA, Yanbeiy N, Eid A, Inderias LA, et al. Bacteremic and nonbacteremic pneumococcal pneumonia. A prospective study. Medicine. 2000;79(4):210–21.PubMedGoogle Scholar
  34. 34.
    Watanakunakorn C, Greifenstein A, Stroh K, Jarjoura DG, Blend D, Cugino A, et al. Pneumococcal bacteremia in three community teaching hospitals from 1980 to 1989. Chest. 1993;103(4):1152–6.PubMedGoogle Scholar
  35. 35.
    Pallares R, Linares J, Vadillo M, Cabellos C, Manresa F, Viladrich PF, et al. Resistance to penicillin and cephalosporin and mortality from severe pneumococcal pneumonia in Barcelona, Spain. N Engl J Med. 1995;333(8):474–80.PubMedGoogle Scholar
  36. 36.
    Alanee SR, McGee L, Jackson D, Chiou CC, Feldman C, Morris AJ, et al. Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study. Clin Infect Dis. 2007;45(1):46–51.PubMedGoogle Scholar
  37. 37.
    Watari M, Ohe M, Kunimoto E, Tsukamoto R, Komagata H. Mortality and prognostic factors in patients with community-acquired pneumonia: an analysis of 231 cases. Nihon Kokyuki Gakkai Zasshi. 2000;38(7):509–17.PubMedGoogle Scholar
  38. 38.
    de Roux A, Cavalcanti M, Marcos MA, Garcia E, Ewig S, Mensa J, et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest. 2006;129(5): 1219–25.PubMedGoogle Scholar
  39. 39.
    Garau J, Baquero F, Perez-Trallero E, Perez JL, Martin-Sanchez AM, Garcia-Rey C, et al. Factors impacting on length of stay and mortality of community-acquired pneumonia. Clin Microbiol Infect. 2008;14(4):322–9.PubMedGoogle Scholar
  40. 40.
    Luna CM, Famiglietti A, Absi R, Videla AJ, Nogueira FJ, Fuenzalida AD, et al. Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina. Chest. 2000;118(5):1344–54.PubMedGoogle Scholar
  41. 41.
    Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK. Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest. 2003;124(6):2148–55.PubMedGoogle Scholar
  42. 42.
    Kyaw MH, Rose Jr CE, Fry AM, Singleton JA, Moore Z, Zell ER, et al. The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults. J Infect Dis. 2005;192(3):377–86.PubMedGoogle Scholar
  43. 43.
    Mufson MA. Pneumococcal infections. JAMA. 1981;246(17):1942–8.PubMedGoogle Scholar
  44. 44.
    Austrian R, Gold J. Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Int Med. 1964;60:759–76.PubMedGoogle Scholar
  45. 45.
    Mufson MA, Kruss DM, Wasil RE, Metzger WI. Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Int Med. 1974;134(3):505–10.Google Scholar
  46. 46.
    Grau I, Ardanuy C, Calatayud L, Rolo D, Domenech A, Linares J, et al. Invasive pneumococcal disease in healthy adults: increase of empyema associated with the clonal-type Sweden(1)-ST306. PLoS One. 2012;7(8):e42595.PubMedGoogle Scholar
  47. 47.
    Cortese MM, Wolff M, Almeido-Hill J, Reid R, Ketcham J, Santosham M. High incidence rates of invasive pneumococcal disease in the White Mountain Apache population. Arch Int Med. 1992;152(11):2277–82.Google Scholar
  48. 48.
    Jacups SP, Cheng A. The epidemiology of community acquired bacteremic pneumonia, due to Streptococcus pneumoniae, in the Top End of the Northern Territory, Australia–over 22 years. Vaccine. 2011;29(33):5386–92.PubMedGoogle Scholar
  49. 49.
    Jover F, Cuadrado JM, Andreu L, Martinez S, Canizares R, de la Tabla VO, et al. A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia. Eur J Int Med. 2008; 19(1):15–21.Google Scholar
  50. 50.
    Gransden WR, Eykyn SJ, Phillips I. Pneumococcal bacteraemia: 325 episodes diagnosed at St Thomas’s Hospital. Br Med J (Clin Res Ed). 1985;290(6467):505–8.Google Scholar
  51. 51.
    Pastor P, Medley F, Murphy TV. Invasive pneumococcal disease in Dallas County, Texas: results from population-based surveillance in 1995. Clin Infect Dis. 1998;26(3):590–5.PubMedGoogle Scholar
  52. 52.
    Burman LA, Norrby R, Trollfors B. Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. Rev Infect Dis. 1985;7(2):133–42.PubMedGoogle Scholar
  53. 53.
    Lujan M, Gallego M, Belmonte Y, Fontanals D, Valles J, Lisboa T, et al. Influence of pneumococcal serotype group on outcome in adults with bacteraemic pneumonia. Eur Respir J. 2010;36(5):1073–9.PubMedGoogle Scholar
  54. 54.
    Perlino CA, Rimland D. Alcoholism, leukopenia, and pneumococcal sepsis. Am Rev Respir Dis. 1985;132(4):757–60.PubMedGoogle Scholar
  55. 55.
    Moss M, Parsons PE, Steinberg KP, Hudson LD, Guidot DM, Burnham EL, et al. Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock. Crit Care Med. 2003;31(3):869–77.PubMedGoogle Scholar
  56. 56.
    Cohen ML. Changing patterns of infectious disease. Nature. 2000;406(6797):762–7.PubMedGoogle Scholar
  57. 57.
    Clavo-Sanchez AJ, Giron-Gonzalez JA, Lopez-Prieto D, Canueto-Quintero J, Sanchez-Porto A, Vergara-Campos A, et al. Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: a multicenter study. Clin Infect Dis. 1997;24(6):1052–9.PubMedGoogle Scholar
  58. 58.
    Aspa J, Rajas O, Rodriguez de Castro F, Blanquer J, Zalacain R, Fenoll A, et al. Drug-resistant pneumococcal pneumonia: clinical relevance and related factors. Clin Infect Dis. 2004; 38(6):787–98.PubMedGoogle Scholar
  59. 59.
    Liljemark WF, Bloomquist C. Human oral microbial ecology and dental caries and periodontal diseases. Crit Rev Oral Biol Med. 1996;7(2):180–98.PubMedGoogle Scholar
  60. 60.
    Berkowitz H, Reichel J, Shim C. The effect of ethanol on the cough reflex. Clin Sci Mol Med. 1973;45(4):527–31.PubMedGoogle Scholar
  61. 61.
    Johnson Jr WD. Impaired defense mechanisms associated with acute alcoholism. Ann N Y Acad Sci. 1975;252:343–7.PubMedGoogle Scholar
  62. 62.
    Krotov NF, Shaumarov ZF, Islamov MS, Ismailov AS, Sergina AP. Changes in the microflora of the suppurative cavities resulting from the treatment of acute bacterial destruction of the lungs. Klin Khir. 1992;9–10:47–9.PubMedGoogle Scholar
  63. 63.
    Wang JL, Chen KY, Fang CT, Hsueh PR, Yang PC, Chang SC. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis. 2005;40(7):915–22.PubMedGoogle Scholar
  64. 64.
    Bartlett JG. Anaerobic bacterial infections of the lung and pleural space. Clin Infect Dis. 1993;16 Suppl 4:S248–55.PubMedGoogle Scholar
  65. 65.
    Schweppe HI, Knowles JH, Kane L. Lung abscess. An analysis of the Massachusets General Hospital cases from 1943 through 1956. N Engl J Med. 1961;265:1039–43.PubMedGoogle Scholar
  66. 66.
    Shafron RD, Tate CF. Lung abscesses; a five-year evaluation. Chest. 1968;53(1):12–8.Google Scholar
  67. 67.
    Barnett TB, Herring CL. Lung abscess. Initial and late results of medical therapy. Arch Int Med. 1971;127(2):217–27.Google Scholar
  68. 68.
    Kharkar RA, Ayyar VB. Aetiological aspects of lung abscess. J Postgrad Med. 1981;27(3): 163–6.PubMedGoogle Scholar
  69. 69.
    Bartlett JG, Finegold SM. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis. 1974;110(1):56–77.PubMedGoogle Scholar
  70. 70.
    Perlman LV, Lerner E, D’Esopo N. Clinical classification and analysis of 97 cases of lung abscess. Am Rev Respir Dis. 1969;99(3):390–8.PubMedGoogle Scholar
  71. 71.
    Bartlett JG. Lung abscesses and necrotizing pneumonia. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious diseases. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 543–7.Google Scholar
  72. 72.
    Kaplan NM, Braude AI. Hemophilus influenzae infection in adults; observations on the immune disturbance. AMA Arch Int Med. 1958;101(3):515–23.Google Scholar
  73. 73.
    Levin DC, Schwarz MI, Matthay RA, LaForce FM. Bacteremic hemophilus influenzae pneumonia in adults. A report of 24 cases and a review of the literature. Am J Med. 1977;62(2): 219–24.PubMedGoogle Scholar
  74. 74.
    Johnson WD, Kaye D, Hook EW. Hemophilus influenzae pneumonia in adults. Report of five cases and review of the literature. Am Rev Respir Dis. 1968;97(6):1112–7.PubMedGoogle Scholar
  75. 75.
    Wrenn KD, Larson S. The febrile alcoholic in the emergency department. Am J Emerg Med. 1991;9(1):57–60.PubMedGoogle Scholar
  76. 76.
    Martin WJ, Spittel JA, Morlock CG, Baggenstoss AH. Severe liver disease complicated by bacteremia due to gramnegative bacilli. AMA Arch Int Med. 1956;98(1):8–15.Google Scholar
  77. 77.
    Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedule—United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(4):1–4.Google Scholar
  78. 78.
    Fuxench-Lopez Z, Ramirez-Ronda CH. Pharyngeal flora in ambulatory alcoholic patients: prevalence of gram-negative bacilli. Arch Int Med. 1978;138(12):1815–6.Google Scholar
  79. 79.
    Hoffman NR, Preston Jr FS. Friedlander’s pneumonia. A report of 11 cases and appraisal of antibiotic therapy. Dis Chest. 1968;53(4):481–6.PubMedGoogle Scholar
  80. 80.
    Tillotson JR, Lerner AM. Pneumonias caused by gram negative bacilli. Medicine. 1966; 45(1):65–76.PubMedGoogle Scholar
  81. 81.
    Limson BM, Romansky MJ, Shea JG. Acute and chronic pulmonary infection with the Friedlander bacillus: a persistent problem in early diagnosis and therapy. Antibiot Annu. 1955–1956;3:786–93.Google Scholar
  82. 82.
    Manfredi F, Daly WJ, Behnke RH. Clinical observations of acute friedlander pneumonia. Ann Int Med. 1963;58(4):642–53.Google Scholar
  83. 83.
    Steinhauer BW, Eickhoff TC, Kislak JW, Finland M. The Klebsiella-Enterobacter-Serratia division. Clinical and epidemiologic characteristics. Ann Int Med. 1966;65(6):1180–94.PubMedGoogle Scholar
  84. 84.
    Limson BM, Romansky MJ, Shea JG. An evaluation of twenty-two patients with acute and chronic pulmonary infection with Friedlander’s bacillus. Ann Int Med. 1956;44(6):1070–81.PubMedGoogle Scholar
  85. 85.
    Feldman C, Smith C, Levy H, Ginsburg P, Miller SD, Koornhof HJ. Klebsiella pneumoniae bacteraemia at an urban general hospital. J Infect. 1990;20(1):21–31.PubMedGoogle Scholar
  86. 86.
    Feldman C, Ross S, Mahomed AG, Omar J, Smith C. The aetiology of severe community-acquired pneumonia and its impact on initial, empiric, antimicrobial chemotherapy. Respir Med. 1995;89(3):187–92.PubMedGoogle Scholar
  87. 87.
    Paganin F, Lilienthal F, Bourdin A, Lugagne N, Tixier F, Genin R, et al. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur Respir J. 2004;24(5):779–85.PubMedGoogle Scholar
  88. 88.
    Jong GM, Hsiue TR, Chen CR, Chang HY, Chen CW. Rapidly fatal outcome of bacteremic Klebsiella pneumoniae pneumonia in alcoholics. Chest. 1995;107(1):214–7.PubMedGoogle Scholar
  89. 89.
    Chen CW, Jong GM, Shiau JJ, Hsiue TR, Chang HY, Chuang YC, et al. Adult bacteremic pneumonia: bacteriology and prognostic factors. J Formos Med Assoc. 1992;91(8):754–9.PubMedGoogle Scholar
  90. 90.
    Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis. 2004;39(1):31–7.PubMedGoogle Scholar
  91. 91.
    Jacoby GA, Han P. Detection of extended-spectrum beta-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli. J Clin Microbiol. 1996;34(4):908–11.PubMedGoogle Scholar
  92. 92.
    Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009;9(4):228–36.PubMedGoogle Scholar
  93. 93.
    Marik PE. The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators. J Crit Care. 2000;15(3):85–90.PubMedGoogle Scholar
  94. 94.
    Chen MZ, Hsueh PR, Lee LN, Yu CJ, Yang PC, Luh KT. Severe community-acquired pneumonia due to Acinetobacter baumannii. Chest. 2001;120(4):1072–7.PubMedGoogle Scholar
  95. 95.
    Falagas ME, Karveli EA, Kelesidis I, Kelesidis T. Community-acquired Acinetobacter infections. Eur J Clin Microbiol Infect Dis. 2007;26(12):857–68.PubMedGoogle Scholar
  96. 96.
    Everts RJ, Murdoch DR, Chambers ST, Town GI, Withington SG, Martin IR, et al. Nosocomial pneumonia in adult general medical and surgical patients at Christchurch Hospital. N Z Med J. 2000;113(1111):221–4.PubMedGoogle Scholar
  97. 97.
    Bard MR, Goettler CE, Toschlog EA, Sagraves SG, Schenarts PJ, Newell MA, et al. Alcohol withdrawal syndrome: turning minor injuries into a major problem. J Trauma. 2006;61(6): 1441–5. discussion 1445–6.PubMedGoogle Scholar
  98. 98.
    Gacouin A, Legay F, Camus C, Volatron AC, Barbarot N, Donnio PY, et al. At-risk drinkers are at higher risk to acquire a bacterial infection during an intensive care unit stay than abstinent or moderate drinkers. Crit Care Med. 2008;36(6):1735–41.PubMedGoogle Scholar
  99. 99.
    Bercault N, Boulain T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case–control study. Crit Care Med. 2001;29(12):2303–9.PubMedGoogle Scholar
  100. 100.
    Jurkovich GJ, Rivara FP, Gurney JG, Fligner C, Ries R, Mueller BA, et al. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA. 1993; 270(1):51–6.PubMedGoogle Scholar
  101. 101.
    Monte R, Rabunal R, Casariego E, Lopez-Agreda H, Mateos A, Pertega S. Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. Alcohol Alcohol. 2010;45(2):151–8.PubMedGoogle Scholar
  102. 102.
    Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003;348(13):1256–66.PubMedGoogle Scholar
  103. 103.
    Frances RJ. Update on alcohol and drug disorder treatment. J Clin Psychiatry 1988;49 Suppl:13–7.Google Scholar
  104. 104.
    Wiecha JL, Dwyer JT, Dunn-Strohecker M. Nutrition and health services needs among the homeless. Public Health Rep. 1991;106(4):364–74.PubMedGoogle Scholar
  105. 105.
    Jones TF, Craig AS, Valway SE, Woodley CL, Schaffner W. Transmission of tuberculosis in a jail. Ann Int Med. 1999;131(8):557–63.PubMedGoogle Scholar
  106. 106.
    Cantwell MF, McKenna MT, McCray E, Onorato IM. Tuberculosis and race/ethnicity in the United States: impact of socioeconomic status. Am J Respir Crit Care Med. 1998;157(4 Pt 1): 1016–20.PubMedGoogle Scholar
  107. 107.
    Classen CN, Warren R, Richardson M, Hauman JH, Gie RP, Ellis JH, et al. Impact of social interactions in the community on the transmission of tuberculosis in a high incidence area. Thorax. 1999;54(2):136–40.PubMedGoogle Scholar
  108. 108.
    Rieder HL. Epidemiologic basis of tuberculosis control. Paris: International Union against Tuberculosis and Lung Disease; 1999.Google Scholar
  109. 109.
    Nelson S, Mason C, Bagby G, Summer W. Alcohol, tumor necrosis factor, and tuberculosis. Alcohol Clin Exp Res. 1995;19(1):17–24.PubMedGoogle Scholar
  110. 110.
    Li X, Grossman CJ, Mendenhall CL, Hurtubise P, Rouster SD, Roselle GA, et al. Host response to mycobacterial infection in the alcoholic rat: male and female dimorphism. Alcohol. 1998;16(3):207–12.PubMedGoogle Scholar
  111. 111.
    Szabo G. Alcohol’s contribution to compromised immunity. Alcohol Health Res World. 1997;21(1):30–41.PubMedGoogle Scholar
  112. 112.
    Bermudez LE, Wu M, Martinelli J, Young LS. Ethanol affects release of TNF and GM-CSF and membrane expression of TNF receptors by human macrophages. Lymphokine Cytokine Res. 1991;10(5):413–9.PubMedGoogle Scholar
  113. 113.
    Bermudez LE, Young LS. Ethanol augments intracellular survival of Mycobacterium avium complex and impairs macrophage responses to cytokines. J Infect Dis. 1991;163(6): 1286–92.PubMedGoogle Scholar
  114. 114.
    Bermudez LE. Effect of ethanol on the interaction between the macrophage and Mycobacterium avium. Alcohol. 1994;11(2):69–73.PubMedGoogle Scholar
  115. 115.
    Mason CM, Dobard E, Zhang P, Nelson S. Alcohol exacerbates murine pulmonary tuberculosis. Infect Immun. 2004;72(5):2556–63.PubMedGoogle Scholar
  116. 116.
    Lonnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alcohol use as a risk factor for tuberculosis—a systematic review. BMC Public Health. 2008;8:289. doi: 10.1186/1471-2458-8-289.PubMedGoogle Scholar
  117. 117.
    Rehm J, Samokhvalov AV, Neuman MG, Room R, Parry C, Lonnroth K, et al. The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health. 2009;9:450. doi: 10.1186/1471-2458-9-450.PubMedGoogle Scholar
  118. 118.
    Burman WJ, Cohn DL, Rietmeijer CA, Judson FN, Sbarbaro JA, Reves RR. Noncompliance with directly observed therapy for tuberculosis. Epidemiology and effect on the outcome of treatment. Chest. 1997;111(5):1168–73.PubMedGoogle Scholar
  119. 119.
    Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One. 2009;4(9):e6914.PubMedGoogle Scholar
  120. 120.
    Zetola NM, Modongo C, Kip EC, Gross R, Bisson GP, Collman RG. Alcohol use and abuse among patients with multidrug-resistant tuberculosis in Botswana. Int J Tuberc Lung Dis. 2012;16(11):1529–34.PubMedGoogle Scholar
  121. 121.
    Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV, et al. Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bull World Health Organ. 2007;85(9): 703–11.PubMedGoogle Scholar
  122. 122.
    Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings. HHS Publication No. (SMA) 11–4658. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011.Google Scholar
  123. 123.
    World Health Organization. Global status report on alcohol and health. Geneva, Switzerland: World Health Organization; 2011.Google Scholar
  124. 124.
    Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for pneumonia: a systematic review and meta-analysis. Epidemiol Infect. 2010;138(12):1789–95.PubMedGoogle Scholar
  125. 125.
    Hoyart DL, Xu J. National Vital Statistics Report—deaths: preliminary data for 2011. 2012;61(6).Google Scholar
  126. 126.
    Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the U.S., 2006. Am J Prev Med. 2011;41(5):516–24.PubMedGoogle Scholar
  127. 127.
    Saitz R, Ghali WA, Moskowitz MA. The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Int Med. 1997;157(13):1446–52.Google Scholar
  128. 128.
    Kornum JB, Due KM, Norgaard M, Tjonneland A, Overvad K, Sorensen HT, et al. Alcohol drinking and risk of subsequent hospitalisation with pneumonia. Eur Respir J. 2012; 39(1):149–55.PubMedGoogle Scholar
  129. 129.
    Garcia-Vidal C, Carratala J, Diaz V, Dorca J, Verdaguer R, Manresa F, et al. Factors associated with prolonged hospital stay in community-acquired pneumonia. Enferm Infecc Microbiol Clin. 2009;27(3):160–4.PubMedGoogle Scholar
  130. 130.
    Stelianides S, Golmard JL, Carbon C, Fantin B. Influence of socioeconomic status on features and outcome of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 1999;18(10):704–8.PubMedGoogle Scholar
  131. 131.
    Mostafa SM, Murthy BV. Alcohol-associated admissions to an adult intensive care unit: an audit. Eur J Anaesthesiol. 2002;19(3):193–6.PubMedGoogle Scholar
  132. 132.
    de Wit M, Zilberberg MD, Boehmler JM, Bearman GM, Edmond MB. Outcomes of patients with alcohol use disorders experiencing healthcare-associated infections. Alcohol Clin Exp Res. 2011;35(7):1368–73.PubMedGoogle Scholar
  133. 133.
    Adamuz J, Viasus D, Camprecios-Rodriguez P, Canavate-Jurado O, Jimenez-Martinez E, Isla P, et al. A prospective cohort study of healthcare visits and rehospitalizations after discharge of patients with community-acquired pneumonia. Respirology. 2011;16(7):1119–26.PubMedGoogle Scholar
  134. 134.
    Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)–United States, 2012–13 influenza season. MMWR Morb Mortal Wkly Rep. 2012;61(32):613–8.Google Scholar
  135. 135.
    Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61(40):816–9.Google Scholar
  136. 136.
    Buchwald D, Sheffield J, Furman R, Hartman S, Dudden M, Manson S. Influenza and pneumococcal vaccination among Native American elders in a primary care practice. Arch Int Med. 2000;160(10):1443–8.Google Scholar
  137. 137.
    Jimenez-Garcia R, Arinez-Fernandez MC, Hernandez-Barrera V, Garcia-Carballo MM, de Miguel AG, Carrasco-Garrido P. Compliance with influenza and pneumococcal vaccination among patients with chronic obstructive pulmonary disease consulting their medical practitioners in Catalonia, Spain. J Infect. 2007;54(1):65–74.PubMedGoogle Scholar
  138. 138.
    Merrick EL, Hodgkin D, Garnick DW, Horgan CM, Panas L, Ryan M, et al. Unhealthy drinking patterns and receipt of preventive medical services by older adults. J Gen Int Med. 2008;23(11):1741–8.Google Scholar
  139. 139.
    Vila-Corcoles A, Salsench E, Rodriguez-Blanco T, Ochoa-Gondar O, de Diego C, Valdivieso A, et al. Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in middle-aged and older adults: a matched case–control study. Vaccine. 2009;27(10):1504–10.PubMedGoogle Scholar
  140. 140.
    McMahon BJ, Parkinson AJ, Bulkow L, Davidson M, Wainwright K, Wolfe P, et al. Immunogenicity of the 23-valent pneumococcal polysaccharide vaccine in Alaska Native chronic alcoholics compared with nonalcoholic Native and non-Native controls. Am J Med. 1993;95(6):589–94.PubMedGoogle Scholar
  141. 141.
    Dominguez A, Izquierdo C, Salleras L, Ruiz L, Sousa D, Bayas JM, et al. Effectiveness of the pneumococcal polysaccharide vaccine in preventing pneumonia in the elderly. Eur Respir J. 2010;36(3):608–14.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Section of Pulmonary and Critical CareLouisiana State University Health Sciences CenterNew OrleansUSA

Personalised recommendations