PNEUMONIA IN PATIENTS WITH DRUG DEPENDENCE

Abstract

The objective of this study was to investigate clinical course of septic pneumonia in patients with intravenous drug dependence. Methods. Routine clinical and radiological examination has been conducted in 55 consecutive pneumonia patients with intravenous narcotic dependence hospitalized in two hospitals at Barnaul city. A comparator group included 19 patients with septic pneumonia without drug abuse. Results. The majority of patients with intravenous drug dependence were younger than 40 years old ( p < 0.001), 42 (76.4 %) were men. HIV infection was detected in 20 patients (36.4 %). Opioid abuse was found in 11 patients, heroin abuse in 16 and desomorphine abuse in 28 patients; 51 patients were diagnosed with viral hepatitis (B, C, or both). In 61.8 % of patients with intravenous drug dependence, severity of pneumonia by CURB-65 score was ³ 3 compared to 2 in 68.4 % of comparative patients (c2 = 5.20, p = 0.044). The average SOFA score was 6.2 ± 1.8. The APACHE II score was > 25 in 29 patients (52.7 %). Severe sepsis (ACC / SCCM, 1992) more often diagnosed in patients with intravenous drug dependence ( n = 31; c2 = 5.10, p = 0.046). In the comparator group, sepsis was diagnosed in 11 patients (c2 = 3.19; p = 0.129). Septic shock was developed in 5 and 3 patients, respectively. Conclusion. In patients with intravenous drug dependence, pneumonia has more severe course with more frequent complications including tricuspid valve infective endocarditis, hepatic injury, bilateral and destructive lung lesions. Apart from adequate antimicrobial therapy, treatment of such patients should be targeted to improvement in microcirculation disorders.