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Incidence, characteristic and outcomes of ventilator-associated pneumonia among type 2 diabetes patients: An observational population-based study in Spain

Published:January 27, 2017DOI:https://doi.org/10.1016/j.ejim.2017.01.019

      Highlights

      • VAP incidence rates were higher among T2DM patients than in non-diabetic patients.
      • Higher mortality rates in diabetic and non-diabetic patients were associated with increasing age.
      • Higher mortality rates in diabetic and non-diabetic patients were associated with presence of comorbidities.
      • Higher mortality rates in all patients were associated with primary diagnoses of vein or artery occlusion.
      • Diabetes does not predict higher mortality in VAP during hospitalization.

      Abstract

      Background

      To describe incidence, characteristics and outcomes of ventilator-associated pneumonia (VAP) during hospitalization among patients with or without type 2 diabetes (T2DM).

      Methods

      We used the Spanish national hospital discharge database to select all hospitalization with VAP in subjects aged 40 years or more from 2010 to 2014. We analyzed incidence, patient comorbidities, procedures, pneumonia pathogens and in-hospital outcomes according to diabetes status (T2DM and no-diabetes). We used propensity score analysis to estimate the effect of T2DM on in-hospital mortality

      Results

      In 7952 admissions, the patient developed a VAP (13.6% with T2DM). Adjusted incidence rate of VAP was slightly, but significantly, higher in T2DM than in non-diabetic patients (36.46[95% CI 34.41–38.51] vs. 32.57[95% CI 31.40–33.74] cases per 100,000/inhabitants). T2DM people were older and had higher Charlson comorbidity index than non-diabetic people. T2DM patients had a lower mean number of failing organs than non-diabetic patients (1.20 SD 1.17 vs. 1.45 SD 1.44, p < 0.001). Pseudomonas was the most frequently isolated agent in both groups. IHM was 41.92% for T2DM patients and 37.91% for non-diabetic patients (p < 0.05). Factors associated with a higher mortality in both groups included: older age, more comorbidities and primary diagnoses of vein or artery occlusion, pulmonary disease and cancer. T2DM was not associated with a higher in-hospital mortality after adjustment using a propensity score (OR 0.88; 95% CI 0.76–1.35).

      Conclusions

      VAP incidence rates were higher among T2DM patients. In-hospital mortality was higher among the older patients and those with more co-morbid conditions. T2DM does not predict higher mortality in VAP during hospitalization.

      Abbreviations:

      CCI (Charlson comorbidity index), CMBD (Spanish National Hospital Discharge Database, Conjunto Mínimo Básico Datos), COPD (chronic obstructive pulmonary disease), ER (emergency room), ICD-9-CM codes (International Classification of Diseases-Ninth Revision, Clinical Modification), ICU (intensive care unit), IHM (in-hospital mortality), LOHS (length of hospital stay), OR (Odds Ratio), T2DM (type 2 diabetes), VAP (ventilator-associated pneumonia)

      Keywords

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