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Purpose: In patients with diabetes mellitus (DM), communityacquired 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 > 4 hours (OR 6.5, 95% CI 2.2 18.8, p = 0.001) and development of complications (OR 5.7, 95% CI 2.1 – 15.4, p = 0.001) 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 (p = 0.001). Independent risk factors for prolonged LOS included presence of complications (HR 0.19, 95% CI: 0.09 – 0.41, P = 0.003), duration of antibiotics (HR 0.9, 95% CI 0.85 – 0.95, p = 0.0002), and administration of systemic steroids (HR 0.51, 95% CI 0.31 – 0.84, p = 0.01). Conclusions: Delayed administration of antibiotics, administration of systemic steroids and CAP related complications were associated with negative outcomes in diabetic patients with moderate-severe CAP.

international journal of respiratory and pulmonary medicine

Outcomes of Moderate-Severe Community-Acquired Pneumonia in Patients with Diabetes Mellitus: Impact of Systemic Steroids and Time to First Dose of Appropriate Antibiotic Therapy