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Risk Factors

• Independent risk factors for CAP include:
  • Alcoholism [relative risk (RR) 9]
  • Asthma (RR 4.2)
  • Immunosuppression (RR 1.9)
  • Age > 70 years (RR 1.5 vs. 60–69 years)
• Risk factors for pneumococcal pneumonia include:
  • Dementia
  • Seizures
  • Congestive heart failure
  • Cerebrovascular disease
  • Tobacco smoking
  • Alcoholism
  • Chronic obstructive pulmonary disease (COPD)
  • HIV infection
    • Risk up to 40 times that in age-matched patients not infected with HIV
• Risk factors for invasive pneumococcal disease include:
  • Male gender
  • African-American race
  • Chronic illness
  • Current tobacco smoking (strongest independent predictor among immunocompetent young adults)
  • Passive exposure to tobacco smoke
  • Immunologic defects
    • Multiple myeloma
    • Nephrotic syndrome with low serum immune globulin levels
    • Splenectomy
    • HIV infection
    • Others
• Risk factors for Legionnaires’ disease include:
  • Male gender
  • Current tobacco smoking
  • Diabetes
  • Hematologic malignancy
  • Cancer
  • End-stage renal disease
  • HIV infection
• Risk factors for gram-negative bacterial pneumonia (including that caused by Pseudomonas aeruginosa)
  • Probable aspiration
  • Previous hospital admission
  • Previous antimicrobial treatment
  • Bronchiectasis
  • Neutropenia
• Alcohol use
  • Heavy drinkers (i.e., those consuming > 100 g of ethanol per day for the preceding 2 years)
    • Higher incidence of gram-negative bacterial pneumonia
    • Worse clinical symptoms
    • Require longer courses of IV antibiotic therapy than do nondrinkers
  • More prolonged fever, slower resolution, and a higher rate of empyema have been noted in pneumococcal pneumonia patients with chronic alcoholism than in their nondrinking counterparts.
  • The clinical entity designated ALPS—alcoholism, leukopenia, and pneumococcal sepsis—is associated with a mortality rate of 80%.
  • Excessive alcohol use is an independent risk factor for the development of acute respiratory distress syndrome (ARDS).

The Harrison's Practice Preview allows you to view 5 FREE complete topics or conduct a search that delivers abstracts for more than 450 medical topics. For full access, please subscribe today!