At-risk drinkers are at higher risk to acquire a bacterial infection during an intensive care unit stay than abstinent or moderate drinkers

Arnaud Gacouin, François Legay, Christophe Camus, Anne-Claire Volatron, Nicolas Barbarot, Pierre-Yves Donnio, Rémi Thomas, Yves Le Tulzo
Critical Care Medicine 2008, 36 (6): 1735-41

OBJECTIVES: To determine whether excessive alcohol consumption increases the risk for intensive care unit (ICU)-acquired bacterial infection, especially ventilator-associated pneumonia (VAP), in nontrauma patients.

DESIGN: Prospective observational cohort study.

SETTING: A 21-bed polyvalent ICU in a university hospital.

PATIENTS: A total of 358 adult patients admitted over a 1-yr period who had an ICU stay > or = 3 days and in whom alcohol consumption could be assessed.

INTERVENTIONS: None. MEASUREMENTS AND MEAN RESULTS: Thirty-one percent of the patients (111 of 358) were identified as at-risk drinkers according to the National Institute on Alcohol Abuse and Alcoholism criteria. Among these, 61 had a daily intake of five or more drinks per day and 73 had Simplified Michigan Alcohol Short Test scores > or = 3. ICU-acquired bacterial infections were diagnosed in 88 patients, and 69 patients had one or more VAPs. Forty (36%) at-risk drinkers acquired bacterial infections vs. 48 (19%) not-at-risk drinkers (p < .001). Among at-risk drinkers, the proportion of patients who developed bacterial infection was higher in at-risk drinkers consuming five or more drinks per day compared with at-risk drinkers consuming fewer than five drinks per day (p = .048). After adjustment for age, gender, Simplified Acute Physiology Score II, length of hospital stay before ICU admission, prior antibiotic administration within 24 hrs before ICU admission, type of admission, immunosuppression, duration of mechanical ventilation, and central venous and urinary catheter exposure, at-risk drinking remained significantly associated with the acquisition of bacterial infection at any site (hazard ratio 1.92; 95% confidence interval, 1.17-3.14; p = .009) and of VAP (hazard ratio 1.76; 95% confidence interval, 1.05-3.06; p = .04).

CONCLUSIONS: At-risk drinking was a significant risk factor for acquisition of ICU-acquired bacterial infection.

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