- •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.
To describe incidence, characteristics and outcomes of ventilator-associated pneumonia (VAP) during hospitalization among patients with or without type 2 diabetes (T2DM).
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
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).
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)
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- Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.Am J Respir Crit Care Med. 2005; 171: 388-416
- Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.Crit Care Med. 2011; 39: 2736-2742
- Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies.Lancet Infect Dis. 2013; 13: 665-671
- Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.Clin Infect Dis. 2016; 63: e61-e111
- National Healthcare Safety Network report, data summary for 2011, device-associated module.Am J Infect Control. 2013; 41: 286-300
- National trends in patient safety for four common conditions, 2005–2011.N Engl J Med. 2014; 370: 341-351
- Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a northern Thai tertiary-care university based general surgical intensive care unit.Infect Drug Resist. 2014; 7: 203-210
- Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] study.Diabetologia. 2012; 55: 88-93
- Influenza and pneumococcal immunization in diabetes.Diabetes Care. 2004; 27: S111-S113
- Pulmonary complications of diabetes mellitus.Pneumonia Infect Dis Clin North Am. 1995; 9: 65-96
- Diabetes mellitus as a risk factor for nosocomial pneumonia and associated mortality.Diabet Med. 2007; 24: 1168-1171
- Trends in ventilator-associated pneumonia rates within the German nosocomial infection surveillance system (KISS).Infect Control Hosp Epidemiol. 2007; 28: 314-318
- Temporal trends of ventilator-associated pneumonia incidence and the effect of implementing health-care bundles in a suburban community.Chest. 2013; 144: 1461-1468
- Trends in ventilator-associated pneumonia: impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit.Am J Infect Control. 2014; 42: 1312-1316
- Hospitales del INSALUD.(accesed 16.01.17)
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med Care. 2005; 43: 1130-1139
- Encuesta Europea de Salud para España.(European Health Survey for Spain 2014)http://www.msssi.gob.es/estadEstudios/estadisticas/EncuestaEuropea/METODOLOGIA_EESE2014.pdf(accessed 06.10.16)Date: 2014
- Population estimates.http://www.ine.es(accessed 06.10.16)Date: 2010
- Risk of hospitalization for diabetic macrovascular complications and in-hospital mortality with irregular physician visits using propensity score matching.J Diabetes Investig. 2014; 5: 428-434
- Variable selection for propensity score models.Am J Epidemiol. 2008; 163: 1149-1156
- PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing.(accessed 06.10.16)
- An assessment of ventilator-associated pneumonias and risk factors identified in the intensive care unit.Pak J Med Sci. 2016; 32: 817-822
- Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus.Mayo Clin Proc. 2005; 80: 1558-1567
- Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients.Crit Care Res Pract. 2013; 2013: 279479
- The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort.Crit Care. 2006; 10: R137
- Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis.Ann Intensive Care. 2016; 6: 34
- An institutional perspective on the impact of recent antibiotic exposure on length of stay and hospital costs for patients with gram-negative sepsis.BMC Infect Dis. 2012; 12: 56
- Clinical outcomes of Pseudomonas aeruginosa pneumonia in intensive care unit patients.Intensive Care Med. 2013; 39: 682-692
- Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa.Crit Care Med. 2014; 42: 2178-2187
- Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.J Clin Endocrinol Metab. 2002; 87: 978-982
- Insulin-treated diabetes is not associated with increased mortality in critically ill patients.Crit Care. 2010; 14: R12
- Diabetes mellitus does not adversely affect outcomes from a critical illness.Crit Care Med. 2010; 38: 16-24
- The effect of diabetes on mortality in critically ill patients: a systematic review and meta-analysis.Crit Care. 2011; 15: R205
- Ventilator-associated pneumonia: epidemiology and prognostic indicators of 30-day mortality.Jpn J Infect Dis. 2015; 68: 181-186
- Factors influencing ventilator-associated pneumonia in cancer patients.Asian Pac J Cancer Prev. 2014; 15: 5787-5791
- Risk factors and pathogens involved in early ventilator-acquired pneumonia in patients with severe subarachnoid hemorrhage.Eur J Clin Microbiol Infect Dis. 2014; 33: 823-830
- Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study.BMC Health Serv Res. 2011; 11: 289
- Predicting in-hospital mortality with coronary bypass surgery using hospital discharge data: comparison with a prospective observational study.Rev Esp Cardiol. 2008; 61: 843-852
- Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.Crit Care Med. 2005; 33: 750-755
- Characteristics and outcomes of elderly patients refused to ICU.ScientificWorldJournal. 2013; 2013: 590837
- Reasons for refusal of admission to intensive care and impact on mortality.Intensive Care Med. 2010; 36: 1772-1779
- Trends in the prevalence of physical and functional disability among Spanish elderly suffering from diabetes (2000–2007).Diabetes Res Clin Pract. 2011; 94: e30-e33
Published online: January 27, 2017
Accepted: January 23, 2017
Received in revised form: January 18, 2017
Received: November 28, 2016
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.