Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED
Journal
American Journal of Emergency Medicine
Journal Volume
32
Journal Issue
12
Pages
1450-1454
Date Issued
2014
Author(s)
Abstract
Methods All patients admitted to the ED of the university hospital from June 2010 to June 2011 with a history of type 2 diabetes mellitus and microbiologically documented BSI were retrospectively enrolled. Demographic characteristics, Charlson comorbidity index, antibiotic therapy, clinical severity, microbiological etiology, and diabetes-related complications were recorded in a standardized form. The major outcome measure was 30-day survival. χ2 Or Student t test was used for univariate analysis, and Cox proportional hazards models were used for multivariate analysis.Results Among 250 enrolled emergency patients with BSI, the overall 30-day mortality rate was 15.5%. Twenty-seven patients (10.7%) developed diabetic ketoacidosis (DKA), and 22 patients (8.8%) developed hyperosmolar hyperglycemic state. On univariate analysis, DKA rather than hyperosmolar hyperglycemic state was associated with adverse outcome. Other risk factors include higher mean glycated hemoglobin level, presence of underlying malignancy, long-term use of steroids, lower respiratory tract infection, and higher Charlson scores. Multivariate analysis identified 3 independent risk factors for early mortality when severity, comorbidity, age, and sex were under control: DKA (hazard ratio, 3.89; 95% confidence interval, 1.6-8.9), inappropriate antibiotics (2.25, 1.05-4.82), and chronic use of steroid (3.89, 1.1-13.2).Conclusion In type 2 diabetic patients with BSI, a substantial proportion of patients developed DKA. This condition was probably underrecognized by clinicians and constituted an independent risk factor for short-term mortality. Other identified risk factors are potentially correctable and may allow preventive efforts to individuals at greatest potential benefit.Objectives The objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED). ? 2014 Elsevier Inc.
SDGs
Other Subjects
antibiotic agent; glucose; glycosylated hemoglobin; hemoglobin A1c; insulin; glycosylated hemoglobin; hemoglobin A1c protein, human; acute kidney failure; adverse outcome; aged; antibiotic therapy; antimicrobial therapy; Article; bacteremia; biliary tract infection; blood culture; bloodstream infection; Charlson Comorbidity Index; community acquired infection; controlled study; diabetic ketoacidosis; diabetic patient; disease severity; emergency patient; emergency ward; Escherichia coli; female; glucose blood level; hemoglobin blood level; hospital admission; human; hyperglycemia; insulin treatment; Klebsiella pneumoniae; liver abscess; liver cirrhosis; lower respiratory tract infection; major clinical study; male; neurologic disease; non insulin dependent diabetes mellitus; observational study; outcome assessment; retrospective study; short term survival; Staphylococcus aureus; Streptococcus; survival rate; urinary tract infection; bacteremia; Community-Acquired Infections; complication; diabetic ketoacidosis; emergency health service; Hyperglycemic Hyperosmolar Nonketotic Coma; Kaplan Meier method; microbiology; middle aged; mortality; non insulin dependent diabetes mellitus; prognosis; proportional hazards model; statistics and numerical data; survival; Aged; Bacteremia; Community-Acquired Infections; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Emergency Service, Hospital; Female; Hemoglobin A, Glycosylated; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Proportional Hazards Models; Retrospective Studies; Survival Analysis
Type
journal article