The outcomes and associated risk factors of moderate-severe community-acquired pneumonia (CAP) in patients with diabetes mellitus(DM) is unknown. The primary objective of the study was to describe the clinical outcomes of moderate-severe CAP and their associated risk factors in hospitalized patients with DM.
A retrospective cohort study of 156 patients with DM hospitalized for moderate-severe CAP at two tertiary medical centers was carried out. Multivariate logistic and cox regression analysis were used to assess factors associated with mortality, complications, and length of hospital stay (LOS).
In the study, 31 (19.9%) patients died and 81(51.9%) had complications. The most common complications were respiratory failure (25.6%) followed by admission to intensive care unit (16%). Twenty three (31.3%) patients who received their first dose of appropriate antibiotic therapy > 4 hours since triage died, while 8 (9.6%) patients who received their first dose of appropriate antibiotic therapy ≤4 hours since triage died (p= 0.001). Twenty three (74.2%) patients who died received their first dose of appropriate antibiotic for CAP >4 hours since triage while 50 (40%) of the survived patients received their first dose >4 hours since triage(p=0.001). In the multivariate analysis, time to first dose of appropriate antibiotic therapy > 4 hours since triage (OR 6.5, 95% CI 2.2 - 18.8, p= 0.001) and development of complications (OR 5.7, 95% CI 2.1 – 15.4, p= 0.001) were associated with increased in hospital mortality. Prolonged LOS was the only factor that was associated with complications of CAP developed after 24 hours of admission (p=0.001). Time to first dose of appropriate antibiotic therapy was not a significant predictor of complications (p=0.2). The mean LOS was 11 days. The presence of complications (HR 0.19, 95% CI: 0.09 – 0.41, P=0.003), duration of antibiotics ( HR 0.9, 95% CI 0.85 – 0.95,p = 0.0002), and use of systemic steroids ( HR 0.51, 95% CI 0.31 – 0.84, p =0.01) were independently associated with prolonged LOS.
Delayed antibiotic administration and development of complications were associated with a negative impact on the outcomes of moderate-severe CAP in patients with DM. Efforts should be made to administer appropriate antibiotic as early as possible to patients with moderate-severe CAP and DM.
Y. Yi, None