title: Diabetes and risk of community-acquired Staphylococcus aureus bacteremia: a population-based case-control study.
abstract: OBJECTIVE
  Patients with diabetes may experience higher risk of Staphylococcus aureus bacteremia (SAB) than patients without diabetes due to decreased immunity or coexisting morbidities. We investigated the risk of community-acquired (CA) SAB in persons with and without diabetes.
  
  
  METHODS
  Using population-based medical databases, we conducted a case-control study of all adults with first-time CA-SAB and matched population controls in Northern Denmark, 2000-2011.
  
  
  METHODS
  Based on conditional logistic regression, we computed odds ratios (ORs) of CA-SAB according to diabetes. We further assessed whether the risk of CA-SAB differed according to various diabetes-related characteristics (e.g. duration of diabetes, glycemic control, and presence of diabetes complications).
  
  
  RESULTS
  We identified 2638 patients with incident CA-SAB, of whom 713 (27.0%) had diabetes, and 26,379 matched population controls (2495 or 9.5% with diabetes). Individuals with diabetes had a substantially increased risk of CA-SAB compared with population controls (adjusted OR = 2.8 (95% confidence interval (CI): 2.5-3.1)). Duration of diabetes of ≥10 years and poor glycemic control conferred higher risk estimates, with an adjusted OR = 2.3 (95% CI: 1.9-2.7) for diabetes with Hba1c < 7% (< 53 mmol/mol) and an adjusted OR = 5.7 (95% CI: 4.2-7.7) for diabetes with Hba1c ≥9% (≥75 mmol/mol). The risk of CA-SAB was particularly high in patient with diabetes complications: adjusted OR = 5.5 (95% CI: 4.2-7.2) with presence of microvascular complications and OR = 7.0 (95% CI: 5.4-9.0) with combined macro- and microvascular complications.
  
  
  CONCLUSIONS
  Diabetes is associated with a substantially increased risk of CA-SAB, particularly in patients with diabetes of long duration, poor glycemic control, and diabetes complications.
authors.affiliation: Department of Clinical MicrobiologyAalborg University Hospital, Aalborg, Denmark Department of Infectious DiseasesAalborg University Hospital, Aalborg, Denmark Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark jesm@rn.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Smit
authors.affiliation: Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Søgaard
authors.affiliation: Department of Clinical MicrobiologyAalborg University Hospital, Aalborg, Denmark Department of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
authors.affiliation: Department of Infectious DiseasesAalborg University Hospital, Aalborg, Denmark Department of Clinical MedicineAalborg University, Aalborg, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.affiliation: Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark.
authors.forename: Trine
authors.initials: T
authors.lastname: Frøslev
authors.affiliation: Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark.
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D055815:Young Adult