Impact of diabetes on mortality among patients with community-acquired bacteremia

https://doi.org/10.1016/j.jinf.2007.01.004Get rights and content

Summary

Objectives

To assess the impact of diabetes on 30-day mortality in patients with community-acquired bacteremia

Methods

We conducted a hospital-based observational study in patients with community-acquired bacteremia who were admitted from the emergency department (ED). Consecutive admitted patients with positive blood cultures obtained in the ED were interviewed and their charts were reviewed. We compared 30-day mortality in diabetic patients with nondiabetic patients. Cox proportional hazards regression was used to estimate the independent effect of diabetes on 30-day mortality.

Results

Among 839 patients in this study, 242 (29%) had diabetes. The median age of these patients was 67 years (interquartile range: 53–77) and 48% were women. The probability of survival at 30 days was not different between the diabetic and the nondiabetic group (84% vs. 77%, respectively; P = 0.15 by Wilcoxon test). On multivariate analysis, diabetes was not associated with an increased risk of 30-day mortality (hazard ratio, 0.82; 95% confidence interval, 0.53–1.26). By contrast, age and higher comorbidity index increased the risk of 30-day mortality. Several markers of disease severity at ED presentation (tachycardia, hypotension, and bandemia) predict 30-day mortality.

Conclusions

Diabetes appears not to have significant impact on 30-day mortality in this study population. This finding should be interpreted in the context that diabetes patients may have an increased incidence of bacteremia.

Introduction

Bacteremia is a potentially life-threatening disease with a high case-fatality rate of 30–40%.1 Diabetic patients may have decreased immunity including depressed polymorphonuclear leukocyte function, and impaired phagocytosis and chemotaxis2, 3 and are thought to be at increased risk for infections and bacteremia.4, 5, 6 However, data are sparse regarding the effect of diabetes on mortality once diabetic patients have become bacteremic. In addition, limited data from previous studies on the association between diabetes and mortality are conflicting in the setting of bacteremia.7, 8, 9, 10 These studies either included nosocomial bacteremia in hospitalized patients,7, 8 or focused on specific bacteremia pathogens.9, 10 Therefore the results may not be generalizable to patients with community-acquired bacteremia. In this frequently encountered patient population, it remains unknown whether diabetes influences mortality.

Based on the findings of impaired cellular immunity among diabetic patients, we hypothesized that diabetes may adversely affect mortality among patients with community-acquired bacteremia. We conducted a hospital-based prospective observational study among bacteremic patients admitted from the emergency department (ED). The objective of this study was to assess the independent effect of diabetes on short-term (30-day) mortality among these bacteremic patients.

Section snippets

Study population

From June 1, 2001 through May 31, 2002, we conducted a hospital-based observational study initiated from the ED of National Taiwan University Hospital in Taipei, Taiwan. This ED serves an urban, university-based medical center with 2100 beds and approximately 100,000 visits annually. Details of the study design and data collection have been published previously.11 The institutional review board approved the study, and the requirement for informed consent was waived. All patients were managed at

Results

During the 1-year study period, a total of 1346 positive blood cultures were obtained in the ED. According to our inclusion and exclusion criteria, 839 patients were included in current analysis. The detailed selection process is illustrated in Fig. 1. The median age of these patients was 67 years (IQR: 53–77) and 48% were women. The overall prevalence of diabetes was 29% in our study population. The majority of the diabetic patients had type 2 diabetes (98%), with a median history of diabetes

Discussion

In the study, we found no evidence to support our hypothesis that diabetes increases the risk of mortality among patients with community-acquired bacteremia. Our data suggest that once diabetic patients have acquired community-acquired bacteremia, diabetes appears not to have significant impact on 30-day mortality.

Our findings are consistent with, and extend, those from prior reports that diabetes does not influence mortality in the setting of bacteremia.7, 8, 10 In a previous study including

Conclusions

In summary, this study provides evidence that diabetes appears not to have significant impact on 30-day mortality once diabetic patients have acquired community-acquired bacteremia. Several patient factors and markers of disease severity at ED presentation better predicts the risk of 30-day mortality than diabetes. However, this finding should be interpreted in the context that diabetes patients may have the increased incidence of bacteremia, and they may still have an overall increased risk of

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