Tobacco Smoking Increases the Risk for Death From Pneumococcal Pneumonia

Bello, Salvador; Menéndez, Rosário; Torres, Antoni; Reyes, Soledad; Zalacaín, Rafael; Capelastegui, Alberto; Aspa, Javier; Borderías, Luis; Martín-Villasclaras, Juan José; Alfageme, Inmaculada; Castro, Felipè Rodríguez de; Rello, Jordi; Molinos, Luis; Ruiz-Manzano, Juan

doi:10.1378/chest.13-2853

Cited by 85 publications

(67 citation statements)

References 45 publications

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“…In addition, we found that cigarette smoke-induced developing CAP and the odds are highest for streptococcal pneumonia (38)(39)(40). Moreover, smoking was found to be an independent risk factor for invasive pneumococcal disease and for CAP-associated mortality in nonelderly adults (41,42). Our findings of increased lung bacterial clearance in mice experimentally exposed to cigarette smoke do not contradict evidence of increased clinical incidence of CAP in human smokers.…”

Section: Discussionsupporting

confidence: 47%

Increased Myeloid Cell Production and Lung Bacterial Clearance in Mice Exposed to Cigarette Smoke

Basilico

Cremona

Oevermann³

et al. 2016

Am J Respir Cell Mol Biol

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Pneumonia is a leading cause of hospitalization in patients with chronic obstructive pulmonary disease (COPD). Although most patients with COPD are smokers, the effects of cigarette smoke exposure on clearance of lung bacterial pathogens and on immune and inflammatory responses are incompletely defined. Here, clearance of Streptococcus pneumoniae and Pseudomonas aeruginosa and associated immune responses were examined in mice exposed to cigarette smoke or after smoking cessation. Mice exposed to cigarette smoke for 6 weeks or 4 months demonstrated decreased lung bacterial burden compared with air-exposed mice when infected 16 to 24 hours after exposure. When infection was performed after smoke cessation, bacterial clearance kinetics of mice previously exposed to smoke reversed to levels comparable to those of control mice, suggesting that the observed defects were not dependent on adaptive immunological memory to bacterial determinants found in smoke. Comparing cytokine levels and myeloid cell production before infection in mice exposed to cigarette smoke with mice never exposed or after smoke cessation revealed that reduced bacterial burden was most strongly associated with higher levels of IL-1β and granulocyte-macrophage colony-stimulating factor in the lungs and with increased neutrophil reserve and monocyte turnover in the bone marrow. Using Serpinb1a-deficient mice with reduced neutrophil numbers and treatment with granulocyte colony-stimulating factor showed that increased neutrophil numbers contribute only in part to the effect of smoke on infection. Our findings indicate that cigarette smoke induces a temporary and reversible increase in clearance of lung pathogens, which correlates with local inflammation and increased myeloid cell output from the bone marrow.

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Section: Discussionsupporting

confidence: 47%

Increased Myeloid Cell Production and Lung Bacterial Clearance in Mice Exposed to Cigarette Smoke

Basilico

Cremona

Oevermann³

et al. 2016

Am J Respir Cell Mol Biol

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“…Doctors may attribute cough in a current smoker to the smoking and hence not prescribe antibiotics. This is in contrast to retrospective European data where current smoking was an independent risk factor for antibiotic prescription in primary care patients presenting with cough and the increased risk of community acquired pneumonia and death of pneumococcal disease in smokers [14,15]. Yet the cough study demonstrated no improved recovery with antibiotics and subgroup analysis of a multi-centre randomised, placebo-controlled trial of amoxicillin versus placebo in LRTI showed no clinically meaningful advantage of antibiotic treatment, supporting our described UK findings [16].…”

Section: Discussioncontrasting

confidence: 68%

Amoxicillin is associated with a lower risk of further antibiotic prescriptions for lower respiratory tract infections in primary care – A database analysis spanning over 30 years

Stolbrink

Bonnett

Blakey

2018

European Clinical Respiratory Journal

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Antibiotic prescriptions for lower respiratory tract infections occur commonly in primary care but there is uncertainty about the most effective initial treatment strategy. Both increasing antimicrobial resistance and awareness of preventable harm from medicines make resolving this uncertainty a priority. Pragmatic, real-life epidemiological investigations are needed to inform future interventional studies.In this cross-sectional database study we analysed antibiotic prescriptions for non-pneumonic, lower respiratory tract infections (LRTI) in primary care as captured in the Optimum Care Database from 1984 to 2017. The primary outcome was a second antibiotic prescription for a LRTI code within 14 days of index prescription, the secondary outcome further antibiotic prescription for any indication. Only individuals without chronic respiratory diseases were included. We conducted univariable analysis to identify factors associated with repeat prescriptions and generate hypotheses for forthcoming projects.We analysed 367,188 index prescriptions for LRTI. Amoxicillin was the commonest used index drug (65.1%). In 6% a second antibiotic course coded for a further LRTI was prescribed (11.2% without this coding restriction). Further antibiotic prescriptions for LRTI were significantly associated with older age, previous smoking, seven day index courses and not using amoxicillin initially. The largest effect size was seen when amoxicillin was not used as index drug (odds ratio (OR) 1.15, p < 0.001). This would support current prescribing practice for amoxicillin as index drug in those without respiratory disease. Prospective studies are needed to explore the observed differences.

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“…Un estudio epidemiológico demostró que el tabaquismo es un factor de riesgo independiente de mortalidad en NAC bacteriémicas por S. pneumoniae 44 . Un reciente estudio español ha investigado la influencia del tabaquismo en la mortalidad por NAC de etiología neumocócica 45 . Se analizaron un total de 4.288 pacientes hospitalizados por NAC.…”

Section: Revisión De Los Estudios Clínico-epidemiológicosunclassified

“…Se encontró que el consumo activo de tabaco fue un factor de riesgo independiente para increementar la mortalidad a los 30 días en los sujetos con NAC de etiología neumocócica, OR, 5,0 (1,(8)(9)(10)(11)(12)(13)5; p 0,001), después de ajustar por diferentes factores de confusión (edad, hepatopatía, sepsis, etc.) 45 .…”

Section: Revisión De Los Estudios Clínico-epidemiológicosunclassified