title: Diabetes and outcome of community-acquired pneumococcal bacteremia: a 10-year population-based cohort study.
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.
  
  
  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 not to have a higher case fatality than nondiabetic patients.
authors.affiliation: Department of Clinical Epidemiology, Aalborg and Aarhus University Hospitals, Aalborg, Denmark. uxreth@aas.nja.dk
authors.forename: Reimar W
authors.initials: RW
authors.lastname: Thomsen
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Hundborg
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Lervang
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Henrik T
authors.initials: HT
authors.lastname: Sørensen
authors.forename: Henrik C
authors.initials: HC
authors.lastname: Schønheyder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D048909:Diabetes Complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000628:therapy; D012042:Registries; D016896:Treatment Outcome