Bloodstream infection in patients with Diabetes Mellitus

ABSTRACT

Introduction: People with diabetes have an increased susceptibility to infections and an increased risk of developing bloodstream infections (BSI). Diabetic patients are more prone to sepsis and have more complications than non-diabetics.

Aim: The aim of the present study was to investigate the role of the Quick Sequential Organ Failure Assessment Score (qSOFA) as a method for detecting precursors of poor prognosis in patients with/without diabetes mellitus.

Material-Methods: This is a prospective observational study. The sample of the study consisted of adult patients who were hospitalized in Pathological departments and had BSI. The qSOFA score was calculated daily based on the parameters and only its maximum value was recorded each day.

Results: The study included 243 patients aged 72.1±15.5 years. In all, 25.1% of patients had diabetes and 59% had complications of diabetes. The positive day of the patients was 5.2±9.4 days. The majority of patients (67.1%) had an infection from the community. Totally,72% of the microorganisms isolated were Gram negative and 28% Gram positive. The duration of hospitalization of patients was 18.1±14.5 days, while the duration of hospitalization of patients with DM was 18.5±15.6 days. Patients with nosocomial infection compared with those with community-based infection had significantly longer positivity days (13±13.1vs. 1.3±1.6,p<0.05), with a significantly higher rate of resistant strain (48, 8% vs. 28.8%,p<0.05) and had significantly longer hospital stay (27.9±18.3vs. 13.3±8.9,p<0.05), QS6 score (0.6±0.7vs. 0.4±0.6, p<0.05), QS7 (0.6±0.7vs. 0.3±0.6, p<0.05), QS8 (0.6±0.7vs. 0.3±0.6,p<0.05) and QS29 (0.8±0.8vs. 0, p<0.05). Patients who had qSOFA≤1 compared with those who had qSOFA≥2 were significantly younger (70.8±16.2vs. 76.8±11.5,p<0.05), died significantly lower (16,9%vs. 72.2%,p<0.05) and had significantly longer hospital stay (18.8±15.1vs. 15.7. 12.1,p <0.05). Diabetes mellitus was negatively associated with the scores qSOFA25(r=-0.424), qSOFA29(r=-0.575), qSOFA30(r=-0.575), qSOFA31(r=-0.564) and qSOFA33(r=-0.674).

Conclusions: Bloodstream infections remain a significant complication in people with diabetes and the awareness of health professionals has the potential to reduce morbidity through early identification, management and prevention of infections.

Keywords: diabetes, becteremia, resistance, qSOFA score, outcome