A Comparative Analysis of Spectrum and Outcome of Common bacterial Infections in Patients with and without Diabetes-a Prospective Hospital Based Study

Abstract

Objective: In this prospective study we analyzed clinical spectrum of infections and there outcome in patients with diabetes mellitus and compared it with nondiabeticcontrols admitted in Endocrinology division of a tertiary care hospital.
Methods: This was a prospective, longitudinal study of 242 diabetic and non-diabetic subjects. Patients were studied in terms of clinical picture, biochemical, hematological and microbiological profile, type and severity of infection, treatment received, and final outcome. There were 142 diabetic patients in group 1 and 100 nondiabetic patients in group 2 served as control. Study subjects were followed for a median period of one year (52 weeks in diabetics, 65 weeks in non-diabetics) after discharge from the ward.
Results: Diabetic patients admitted because of infections were older than their non-diabetic counterparts (74% vs 51%> 50 years; p<0.001) and mounted a less inflammatory response in terms of fever and leucocytosis(55% vs 82%:P<0.001).Urinary tract infections were the commonest infections observed among in-hospital diabetic as well as non-diabetic patients (36% vs. 30%; P>0.3). Diabetics contract some specific infections exclusively, like emphysematous pyelonephritis and foot infections, while respiratory infections were more commonly seen in nondiabetic patients (31% vs. 11%; P<0.001).Staphylococcus aureus was the commonest organism involved in soft tissue and diabetic foot infections (32% vs. 19%; P<0.03). Though mean hospital stay was equal in either group it was significantly longer in diabetic subjects when statistically adjusted for APACHE score.Comparative mortality rates were higher in non-diabetics with in-hospital deaths, followup deaths and total deaths of11%, 6.1% and 17.2% vs 4.9%, 4% and 9.1% respectively but re-infections on follow-up occurred more in diabetics (15% vs.2.6%; P=0.005).
Conclusion: Poor glycaemic control and less inflammatory response in terms of fever and leucocytosis, longer hospital stay with increased chances of reinfections are poor prognostic indicators for outcomes in diabetic patients admitted with infections. Urinary tract infections and soft tissue infections particularly foot infectionsare causes of concern in our diabetic patients. JMS 2018: 21 (2):84-90