Diabetes mellitus is an independent risk factor for ICU-acquired bloodstream infections

Michalia, Martha; Kompoti, Maria; Koutsikou, Anastasia; Paridou, Alexandra; Giannopoulou, Panagiota; Trikka-Graphakos, Eleftheria; Clouva-Molyvdas, Phyllis-Maria

doi:10.1007/s00134-008-1288-0

Cited by 46 publications

(35 citation statements)

References 23 publications

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“…The search revealed nine publications that reported differences between men and women with respect to incidence of BSI (Table 5, available online). [23][24][25][26][27][28][29][30][31] Controlling for a variety of covariates, three of the articles reported that men had significantly higher infection rates than women, and six reported no significant gender differences. Although the majority found no significant gender differences, the fact that all studies reporting significant differences found that males were at higher risk suggests a possible association.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Risk of Bloodstream and Surgical Site Infections

et al. 2013

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BACKGROUND:Identifying patients most at risk for hospital-and community-associated infections is one essential strategy for preventing infections. OBJECTIVE: To investigate whether rates of community-and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN: Retrospective cohort study. PARTICIPANTS: All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES: Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS: Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0. 85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥70 years). CONCLUSIONS: In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.

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Section: Discussionmentioning

confidence: 99%

Gender Differences in Risk of Bloodstream and Surgical Site Infections

et al. 2013

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“…Besides being a major cause of urinary infection, Escherichia coli was also the main cause of generalized bacteremia and sepsis. Michalia and associates found that despite the strict control and regulation of blood glucose, diabetics 1,7 times more likely develop septicemia in the Intensive care unit, in comparison with patients without diabetes (5). …”

Section: Discussionmentioning

confidence: 99%

Poorly Regulated Blood Glucose in Diabetic Patients-predictor of Acute Infections

Bureković

Dizdarevic-Bostandzic

Godinjak

2014

Med Arh

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Introduction:Diabetes mellitus, the most frequent endocrinology disease is a predisposing factor for infections. Diabetic patients have 4,4 times greater risk of systemic infection than non diabetics. Aim: a) To determine the prevalence and characteristics of acute infectious diseases in hospitalized diabetics; b) To correlate values of blood glucose levels and HbA1c with acute infections in hospitalized diabetics; c) To identify the etiology of infectious diseases.Material and methods:The study included 450 diabetic patients hospitalized in the 24-month period in the Intensive care unit of the Clinic for Endocrinology, Diabetes and Metabolic Disorders CCUS. In 204 patients (45,3%) there was an acute infectious condition and the following data was registered: a) gender and age; b) basic illness; c) laboratory parameters of inflammation (Le, CRP); d) blood glucose upon admission, parameters of glucoregulation (HbA1c, fructosamine); e) type of infection; f) verification of etiological agent; g) late complications of diabetes; and h) outcome.Results:Out of 204 diabetic patients with infection, there was 35,3% men and 64,7% women. More than half of patients (61%) were in the age group 61-80 years. The most common primary disease was Diabetes mellitus type 2. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection compared to diabetics without acute infection. There is a positive correlation between HbA1c levels and CRP, and blood glucose and CRP in diabetic patients with acute infection. Most frequent infections: urinary tract infection (70,0%), followed by respiratory infections (11,8%), soft tissue infections (10,3%), generalized–bacteremia / sepsis (6,9%). The most common cause of urinary infection and generalized infection was Escherichia colli. The most common bacteria causing soft tissue infections was Staphylococcus aureus.Conclusion:Almost half (45,3%) of hospitalized diabetic patients had acute infectious condition. They present most frequently in women, aged 61-80 years, with Type 2 Diabetes mellitus. HbA1c and fructosamine were significantly increased in diabetic patients with acute infection. There is a positive correlation between the parameters of inflammation and glucoregulation in diabetics with acute infection. Most frequent was a urinary tract infection and the most common causative agent was Escherichia coli. The most common cause of soft tissue infections was Staphylococcus aureus. Out of 21 patients with verified soft tissue infections, 18 of them (85,7%) had confirmed diagnosis of diabetic microangiopathy diabetica. A total of 96,1% of patients fully recovered.

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“…For example, chronic diabetic macro-and micro-vascular disease likely increases the heterogeneity of blood flow and tissue metabolism in acute sepsis. DM is suggested to be an independent risk factor for intensive care unit bloodstream infections (without increasing mortality) (19). However, DM may be associated with anti-inflammatory effects of exogenous insulin used for treating hyperglycemia, (20) offer renal protection against acute kidney injury, (21) decrease the incidence of acute lung injury, (22)(23)(24) and increase overall provider vigilance.…”

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confidence: 99%