Smoking and alcohol abuse are the most preventable risk factors for invasive pneumonia and other pneumococcal infections.
OBJECTIVE
To determine the prevalence of smoking and alcohol abuse among patients with invasive pneumococcal disease (IPD) in order to promote prevention strategies.


METHODS
We prospectively studied all culture-proven IPD cases in patients aged ≥ 18 years during the period 1997-2011. The habits of smoking and alcohol abuse were evaluated. Pneumococcal serotyping was performed.


RESULTS
There were 1378 IPD cases, with a mean age of 61 ± 17 years; 65% were males. Compared to the general population aged 18-64 years, patients with IPD of the same age group were more often current smokers (57% vs. 35%, p < 0.001) and alcohol abusers (21% vs. 6%, p < 0.001). Among patients with IPD, young adults (aged 18-49 vs. 50-64 vs. ≥ 65 years) were more commonly current smokers (71% vs. 40% vs.14%, p < 0.001) and alcohol abusers (23% vs. 18% vs. 6%, p < 0.001). Males were more frequently smokers and alcohol abusers than females. Smokers and alcohol abusers more often had underlying diseases such as HIV infection and chronic liver disease. Pneumonia was more common in smokers and peritonitis in alcohol abusers. Alcohol abuse conferred higher mortality. Certain pneumococcal serotypes, such as serotypes 1, 8, and 23F, more frequently caused IPD in smokers, and serotypes 4, 11A, and 19F in alcohol abusers.


CONCLUSIONS
Smoking and alcohol abuse are the most preventable risk factors for IPD. Implementing smoking and alcohol abuse cessation programs and a pneumococcal vaccination schedule are essential to diminish the burden of pneumonia and other pneumococcal infections.
Infectious Disease Department, Hospital Bellvitge, Idibell, University of Barcelona, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain; CIBERES, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain.
Imma
I
Grau
CIBERES, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain; Microbiology Department, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain.
Carmen
C
Ardanuy
CIBERES, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain; Microbiology Department, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain.
Laura
L
Calatayud
Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, Germany.
Marco H
MH
Schulze
CIBERES, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain; Microbiology Department, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain.
Josefina
J
Liñares
Infectious Disease Department, Hospital Bellvitge, Idibell, University of Barcelona, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain; CIBERES, Hospital Bellvitge, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: rpallares@ub.edu.
Roman
R
Pallares
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D065288:Serogroup; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification; D055815:Young Adult
Alcohol; Mortality; Pneumonia; Serotypes; Smoking; Streptococcus pneumoniae