Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia A 10-year population-based cohort study Reimar W. Thomsen , MD 1 , Heidi H. Hundborg , MSC, PHD 1 , Hans-Henrik Lervang , MD, PHD 2 , Søren P. Johnsen , MD, PHD 1 , Henrik T. Sørensen , MD, DMSC 1 and Henrik C. Schønheyder , MD, DMSC 3 1 Department of Clinical Epidemiology, Aalborg and Aarhus University Hospitals, Aalborg, Denmark 2 Department of Endocrinology, Aalborg and Aarhus University Hospitals, Aalborg, Denmark 3 Department of Clinical Microbiology, Aalborg and Aarhus University Hospitals, Aalborg, Denmark Address correspondence and reprint requests to Reimar Wernich Thomsen, MD, Department of Clinical Epidemiology, Aalborg and Aarhus University Hospitals, Stengade 10, 2nd floor, DK-9000 Aalborg, Denmark. E-mail: uxreth{at}aas.nja.dk Abstract OBJECTIVE —Patients with diabetes may carry a higher case fatality of invasive pneumococcal infection compared with nondiabetic patients due to decreased immunity, risk of metabolic derangement, or angiopathy. We conducted a population-based cohort study to assess the impact of diabetes on mortality within 90 days in patients with pneumococcal bacteremia. RESEARCH DESIGN AND METHODS —All patients with community-acquired pneumococcal bacteremia in North Jutland County, Denmark, from January 1992 to December 2001 were retrieved from the County Bacteremia Registry. Using civil registry numbers, patients with diabetes were identified by record linkage with the County Prescription Database (for antidiabetic drugs) and the County Hospital Discharge Registry. Mortality within 90 days was determined through the Central Population Registry. Mortality rates were compared for diabetic and nondiabetic patients and adjusted for sex, age, and comorbidity. RESULTS — Among 628 patients aged >15 years with community-acquired pneumococcal bacteremia, 63 (10.0%) had diabetes. The diabetic patients were slightly older (median age 71.7 years) than the nondiabetic patients (67.0 years), and the proportion of patients with comorbidity was higher in the diabetic group (59 vs. 46%). Mortality in diabetic patients compared with nondiabetic patients was 11.1 vs. 16.5% after 30 days and 16.0 vs. 19.5% after 90 days, respectively. After adjustment for sex, age, and comorbidity, the mortality rate ratio for diabetic patients was 0.6 (95% CI 0.3–1.2) compared with the nondiabetic patients. CONCLUSIONS —Diabetic patients with community-acquired pneumococcal bacteremia appear n