Prognosis of severe community-acquired pneumonia in alcoholic patients hospitalized in intensive care

The purpose of our study was to determine prognosis factors of alcoholic patients hospitalised in an intensive care unit with severe community-acquired pneumonia (SCAP). Chronic alcoholism was defined by intake of pur alcohol more than 36 g per day for more than one year and severe community-acquired pneumonia by the criteria of the American Thoracic Society. 50 patients were included. Mortality rate was 48% in the department and 68% at two months after dismissal from intensive care. 1 Yen percent of patients were admitted in a state of shock (100% mortality). The most frequent pathogen was Streptococus pneumoniae (38%). The major complications were: 24% acute respiratory distress syndrome (ARDS), 18% multi-organ failure, 48% disseminated intravascular coagulopathy (DIC), 48% pulmonary superinfection. Antibiotherapy was not conform to current guidelines in 20% of cases and hence led to 90% death. Mortality rate was higher than in other studies. Bad prognosis factors were identified: severe state on admission, shock on admission or subsequently, non adapted initial antibiotherapy, Child's score B and C, Streptococus pneumoniae, complications: ARDS, superinfections, coagulopathy, multi organ failure.