Diabetes and hemoglobin a1c as risk factors for nosocomial infections in critically ill patients.
Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012.


METHODS
ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91-20.17; P = 0.002) and blood transfusion 3.33 (1.23-9.02; P = 0.018) were independent risk factors for VAP. BSI in ICU (P = 0.044) and ICU mortality (P = 0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14-5.29; P = 0.022) and stroke on admission2.77 (1.12-6.88; P = 0.029). Sepsis 3.34 (1.47-7.58; P = 0.004) and parenteral feeding 6.29 (1.59-24.83; P = 0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.
Department of Critical Care Medicine, University Hospital of Larissa, University of Thessaly School of Medicine, Biopolis, GR41000 Larisa, Greece.
Eirini
E
Tsakiridou
Department of Critical Care Medicine, University Hospital of Larissa, University of Thessaly School of Medicine, Biopolis, GR41000 Larisa, Greece.
Demosthenes
D
Makris
Department of Critical Care Medicine, General Hospital of Serres, GR62100 Serres, Greece.
Vasiliki
V
Chatzipantazi
Department of Critical Care Medicine, General Hospital of Serres, GR62100 Serres, Greece.
Odysseas
O
Vlachos
Department of Critical Care Medicine, General Hospital of Serres, GR62100 Serres, Greece.
Grigorios
G
Xidopoulos
Department of Critical Care Medicine, General Hospital of Serres, GR62100 Serres, Greece.
Olympia
O
Charalampidou
Department of Hematology Laboratory, General Hospital of Serres, GR62100 Serres, Greece.
Georgios
G
Moraitis
Department of Critical Care Medicine, University Hospital of Larissa, University of Thessaly School of Medicine, Biopolis, GR41000 Larisa, Greece.
Epameinondas
E
Zakynthinos