title: Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED.
abstract: OBJECTIVE
  The objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED).
  
  
  METHODS
  All patients admitted to the ED of the university hospital from June 2010 to June 2011 with a history of type 2 diabetes mellitus and microbiologically documented BSI were retrospectively enrolled. Demographic characteristics, Charlson comorbidity index, antibiotic therapy, clinical severity, microbiological etiology, and diabetes-related complications were recorded in a standardized form. The major outcome measure was 30-day survival. χ2 Or Student t test was used for univariate analysis, and Cox proportional hazards models were used for multivariate analysis.
  
  
  RESULTS
  Among 250 enrolled emergency patients with BSI, the overall 30-day mortality rate was 15.5%. Twenty-seven patients (10.7%) developed diabetic ketoacidosis (DKA), and 22 patients (8.8%) developed hyperosmolar hyperglycemic state. On univariate analysis, DKA rather than hyperosmolar hyperglycemic state was associated with adverse outcome. Other risk factors include higher mean glycated hemoglobin level, presence of underlying malignancy, long-term use of steroids, lower respiratory tract infection, and higher Charlson scores. Multivariate analysis identified 3 independent risk factors for early mortality when severity, comorbidity, age, and sex were under control: DKA (hazard ratio, 3.89; 95% confidence interval, 1.6-8.9), inappropriate antibiotics (2.25, 1.05-4.82), and chronic use of steroid (3.89, 1.1-13.2).
  
  
  CONCLUSIONS
  In type 2 diabetic patients with BSI, a substantial proportion of patients developed DKA. This condition was probably underrecognized by clinicians and constituted an independent risk factor for short-term mortality. Other identified risk factors are potentially correctable and may allow preventive efforts to individuals at greatest potential benefit.
authors.affiliation: Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Yo
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Meng-Tse Gabriel
authors.initials: MT
authors.lastname: Lee
authors.affiliation: Institute of Public Health, Heidelberg University, Heidelberg, Germany.
authors.forename: Weng-Tein
authors.initials: WT
authors.lastname: Gi
authors.affiliation: Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Family Medicine and Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Kuang-Chau
authors.initials: KC
authors.lastname: Tsai
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan. Electronic address: cclee100@gmail.com.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000382:microbiology; D016883:Diabetic Ketoacidosis / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human