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Published on: February 23, 2014
Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced
Belén Millet Pascual-Leone1, Facundo Fiocca Vernengo1, David Hillus1
1Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Purpose:
Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM-) patients in a European CAP cohort.
Methods:
Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002-2022, with and without a history of DM, were conducted.
Results:
Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM- patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31-202) vs. 86 mg/L (IQR: 24-190), p < 0.0001; median leucocyte count 12/nl (IQR: 9-16)vs. 11/nl (IQR: 8-15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM- patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), padj < 0.01).
Conclusions:
CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.
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