Journal of Pulmonology and Clinical Research

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Short Communication - Journal of Pulmonology and Clinical Research (2021) Volume 4, Issue 6

Pneumonia with diabetes mellitus: The impact of systemic steroids and the time to first dose of antibiotics

Community-Acquired Pneumonia (CAP) is the leading cause of infection related hospitalization and a major cause of morbidity and mortality in developing countries. CAP associated mortality in hospitalized patient's ranges from 8% to14% and up to 37% in patients admitted to the Intensive Care Unit (ICU). Several factors including age, septic shock, confusion and multipolar pneumonia have been associated with increased mortality. Validated scores, such as CURB-65 and Pneumonia Severity Index (PSI), are commonly used to predict mortality. In addition, patients with Diabetes Mellitus (DM) are at an increased risk of developing infections and complications with CAP being the most common. Studies have shown that pre-existing diabetes was associated with a higher risk of death following CAP. Factors associated with increased mortality in these patients included multipolar infiltrates, comorbidities, age, bacteremia, septic shock, infection with Gram-negative organisms and hyperglycemia. However, previous studies did not assess the impact of time from triage to administration of first dose of appropriate antibiotics in CAP complication rates LOS or mortality. Finally, clinical characteristics and outcomes of hospitalized diabetics with moderate-severe CAP are unknown. In previous work, we found that a delay in administration of first dose antibiotics in this patient population was associated with increased in-hospital mortality. However, we did not include all degrees of severity nor evaluate other outcomes. The primary objective of this study was to describe the clinical characteristics and risk factors for moderate-severe CAP in hospitalized patients with DM including outcomes such as development of complications, LOS and in-hospital mortality.
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Abstract

Purpose: In patients with Diabetes Mellitus (DM), Community-Acquired Pneumonia (CAP) is associated with significant morbidity and mortality. The primary objective of the study was to describe the clinical outcomes and risk factors for moderate-severe CAP in hospitalized patients with DM. Methods: We conducted a retrospective cohort study of 156 hospitalized patients with DM and moderate-severe CAP at two tertiary medical centers. Multivariate logistic and Cox regression analysis were applied to assess factors associated with complications, length of hospital stay (LOS) and mortality. Results: Thirty one (19.9%) patients died and 81(51.9%) experienced complications during the study period. Common complications included respiratory failure (25.6%) followed by intensive care admission (16%). In the multivariate analysis, time from triage to first dose of appropriate antibiotic therapy and development of complications were associated with increased CAP related in-hospital mortality. The mean LOS was 11 days and patients developing CAP related complications 24 hours post admission had prolonged LOS. Independent risk factors for prolonged LOS included presence of complications, duration of antibiotics, and administration of systemic steroids. Conclusion: Delayed administration of antibiotics, administration of systemic steroids and CAP related complications were associated with negative outcomes in diabetic patients with moderate-severe CAP.
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