Chest
Volume 128, Issue 5, November 2005, Pages 3233-3239
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Clinical Investigations: INFECTION
Etiology and Outcome of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

https://doi.org/10.1378/chest.128.5.3233Get rights and content

Study objectives: It has been suggested that diabetes mellitus is associated with an increased susceptibility to infection, the risk of using more aggressive therapeutic agents, and increased morbidity and mortality; however, current evidence supporting these events in the field of pneumonia is scarce. The aim of the present study was to provide information on clinical and microbiological characteristics and the outcome of community-acquired pneumonia in patients with diabetes mellitus.

Design: Prospective study of cases.

Setting: A university hospital in Lleida, Spain.

Patients: During a 5-year period, we prospectively studied the clinical and radiologic characteristics, the spectrum of causative agents and other microbiological data, and the outcomes of 660 consecutive episodes of community-acquired pneumonia. Data derived from 106 patients with diabetes mellitus were analyzed and compared with data obtained from the remaining population.

Measurements and results: Patients with diabetes mellitus were significantly older (p = 0.001) and more frequently had other concomitant comorbid conditions (p = 0.018). Diabetes was also significantly associated with the development of pleural effusion (p = 0.015) and mortality (p = 0.002); for both events, diabetes remained as an independent predictive factor in multivariate analyses. By contrast, the incidence of the main etiologic agents, and the bacteremia or empyema rates did not show significant differences in relation to the remaining patients. In the subgroup of patients with diabetes, mortality was associated with the presence of multilobar infiltrates (p = 0.004), concomitant underlying diseases (p = 0.004), and some diabetes-related complications (nephropathy, p = 0.040; and vasculopathy, p = 0.002), although only multilobar infiltrates and comorbidities were selected as prognostic factors in the multivariate analysis.

Conclusions: In patients with community-acquired pneumonia, diabetes mellitus is associated with a poor prognosis, increasing the rate of pleural effusion and mortality. Our results suggest that this adverse outcome is more attributable to the underlying circumstances of patients than to uncommon microbiological findings.

Section snippets

Setting and Study Design

For a 5-year period (January 1998 to December 2002), all adult patients in whom community-acquired pneumonia had been diagnosed in the emergency department of the Arnau de Vilanova Hospital in Lleida (Catalonia, Spain) were evaluated for inclusion in a prospective study on epidemiologic, clinical, microbiological, and outcome parameters. This study was examined and approved by the scientific and ethics committees of the institution.

Clinical Evaluation of Patients

On study enrollment, all patients gave a complete clinical

RESULTS

Seven hundred twenty-six patients showing clinical and radiologic findings of community-acquired pneumonia were enrolled in the study; however, 66 patients were subsequently excluded from the study for the following reasons: misdiagnosis at enrollment (n = 59); nosocomial acquisition hospitalization (n = 4); and consent not obtained (n = 3). Thus, 660 patients constituted the final study group. Underlying diseases were found in 324 patients (49%), among which COPD (114 patients), diabetes

DISCUSSION

In this study, we evaluated 106 episodes of community-acquired pneumonia in patients with diabetes mellitus, and the results were compared with those observed in a population of 554 patients with community-acquired pneumonia who did not have diabetes. We found that diabetes was significantly associated with advanced age, the simultaneous presence of other comorbidities, and radiologic evidence of pleural effusion; these episodes were classified as more severe pneumonia, and the rates of

ACKNOWLEDGMENTS

We thank Javier Trujillano, MD, for his contribution to the statistical analysis of the data.

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