Case-control study identifies alcohol use and shifting microbial patterns in severe community-acquired pneumonia, highlighting the need for tailored empiric antimicrobial therapies.
Key Points
To identify independent clinical risk factors for severe community-acquired pneumonia and evaluate temporal shifts in pathogen epidemiology compared to a historical intensive care unit cohort.
Conducted a hospital-based matched case-control study comparing 89 patients with severe community-acquired pneumonia requiring ICU admission to 89 hospitalized control patients with non-severe pneumonia.
Identified microbial etiologies using both noninvasive and invasive diagnostic methods and evaluated shifts relative to ICU baseline data from 1984 to 1987.
Alcohol intake ≥ 80 g/day was an independent risk factor for severe disease (OR 3.9, 95% CI 1.4 to 10.6, p = 0.008), whereas prior outpatient antimicrobial treatment was protective (OR 0.37, 95% CI 0.17 to 0.79, p = 0.009).
Streptococcus pneumoniae remained the predominant pathogen at 24% (with 48% drug resistance), while atypical pathogens increased (17% vs 6%, p = 0.006) and Legionella spp. decreased (2% vs 14%, p = 0.004) compared to historical data.