Antibiotic administration longer than eight hours after triage and mortality of community-acquired pneumonia in patients with diabetes mellitus

Abstract

Studies have established that diabetic patients with community-acquired pneumonia (CAP) may have increased mortality. The primary objective of this study was to investigate if time to first appropriate antibiotic in the emergency department (ED) was associated with in-hospital mortality of CAP in patients with diabetes mellitus (DM). This was a retrospective cohort study of adult diabetic patients who were admitted with CAP. Patients were stratified into two groups: those who received first dose of appropriate antibiotic within 8 hours of triage and those who received it later than 8 hours. A multiple logistic regression analysis was performed. Two hundred six patients were included in the study. Fifty-nine patients (28.6%) had complications of CAP on admission and 31 patients (16%) died. In-hospital mortality was higher in patients who received their initial appropriate antibiotic after 8 hours of triage than those who received it within 8 hours [18 (35.3%), 15 (9.7%), p < 0.0001]. Time to first appropriate antibiotic later than 8 hours of triage was associated with increased in-hospital mortality (OR 4, 95% CI 1.2-13.1, p = 0.02). Antibiotic administration later than 8 hours of triage in the ED was associated with increased in-hospital mortality of CAP among patients with DM.

Clinical Features, Etiology, and Outcomes of Community-Acquired Pneumonia in Patients With Diabetes Mellitus

“…12,14,17 Interestingly, a 2011 study documented that antibiotic administration later than 8 hours after triage in the emergency department was associated with increased inhospital mortality among patients with DM and CAP. 3 Similarly, hyperglycemia at admission predicted increased pneumonia-related mortality in another study. 25 Another study 38 documented that the mechanism of higher risk of death within the first year after CAP in patients with DM is not due to an altered immune response, at least as measured by a broad panel of circulating and cell surface markers, but may be due to worsening of preexisting cardiovascular and kidney disease.…”

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

“…However, it is important to note that a correct diagnosis is a prerequisite. Physicians should not ignore necessary differential diagnosis for the purpose of early diagnosis (II B). For mild CAP outpatients, oral anti‐infective agents with high bioavailability should be used when possible. Oral treatment with amoxicillin or amoxicillin‐clavulanic acid is recommended (I B).…”

Benefit of adjunct corticosteroids for community-acquired pneumonia in diabetic patients

“…Similar to a general CAP population, higher CAP severity scores (e.g. PSI [pneumonia severity index], CURB65 [confusion, blood urea nitrogen, respiratory rate, low blood pressure, age ≥ 65 years] and A-DROP [age, dehydration, respiratory failure, orientation disturbance, low blood pressure] [1][2][3][8][9][10]), time to antibiotics, early complications, advanced age, multilobar infiltrates and comorbidities predict death in a diabetic cohort with CAP [5,11]. Diabetes-specific risk factors predicting outcome include persistent hyperglycaemia during hospitalisation and presence of long-term diabetes complications like retinopathy and nephropathy [3,10,12].…”