title: Community-Acquired Pneumonia in Patients With Diabetes Mellitus: Predictors of Complications and Length of Hospital Stay.
abstract: The primary objective of the study was to determine factors associated with complications and length of hospital stay (LOS) in hospitalized adult patients with diabetes along with community-acquired pneumonia (CAP). CAP is a common infection in patients with diabetes mellitus and is associated with a significant mortality and morbidity.
  
  
  
  This is a retrospective cohort study of 215 adult patients with diabetes who were admitted with CAP. A multivariate logistic and Cox regression analysis were used to assess factors associated with complications and LOS of CAP, respectively.
  
  
  
  During the follow-up period from admission until discharge, 94 patients (43.7%) developed complications. Respiratory failure was the most common complication (43.6%). The average LOS of study cohort was 9.47 days. In the multivariate analysis, complications of CAP were associated with time to first dose of appropriate antibiotic therapy >8 hours since triage at emergency department (ED) (odds ratio = 3.16; 95% CI: 1.58-6.32; P = 0.001) and pneumonia severity index score >90 (odds ratio = 3.52; 95% CI: 1.45-8.53; P = 0.005). In the multivariate Cox regression analysis, time to first dose of appropriate antibiotic therapy >8 hours since triage at ED (hazard ratio [HR] = 0.56, P = 0.01), pneumonia severity index score >90 (HR = 0.62, P = 0.01), presence of complications (HR = 0.53, P = 0.002), duration of antibiotics (HR = 0.90, P ≤ 0.0001) and duration of symptoms prior presentation to ED (HR = 0.96, P = 0.04) were independently determinants of LOS.
  
  
  
  Delayed administration of appropriate antibiotic therapy at ED and moderate-to-severe pneumonia were associated with both increased risk of complications and prolonged LOS in hospitalized adult patients with diabetes along with CAP.
authors.affiliation: Faculty of Health Sciences, Division of Infectious Diseases, Department of Medicine, Memorial University, Newfoundland and Labrador, Canada. Electronic address: msbader1@gmail.com.
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Bader
authors.affiliation: Faculty of Medicine, Division of Community Health, Memorial University, Newfoundland and Labrador, Canada.
authors.forename: Yanqing
authors.initials: Y
authors.lastname: Yi
authors.affiliation: School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada.
authors.forename: Kassem
authors.initials: K
authors.lastname: Abouchehade
authors.affiliation: Department of Medicine, Memorial University, Newfoundland and Labrador, Canada.
authors.forename: Babar
authors.initials: B
authors.lastname: Haroon
authors.affiliation: School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Bishop
authors.affiliation: School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Hawboldt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D048909:Diabetes Complications / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Community-acquired pneumonia; Complications; Diabetes mellitus; Length of hospital stay