Diabetes and Hemoglobin A1c as Risk Factors for Nosocomial Infections in Critically Ill Patients

Objective . To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods . Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. Inclusion criteria: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results . The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91–20.17; P = 0.002) and blood transfusion 3.33 (1.23–9.02; P = 0.018) were independent risk factors for VAP. BSI in ICU ( P = 0.044) and ICU mortality ( P = 0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14–5.29; P = 0.022) and stroke on admission2.77 (1.12–6.88; P = 0.029). Sepsis 3.34 (1.47–7.58; P = 0.004) and parenteral feeding 6.29 (1.59–24.83; P = 0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion . DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.