title: Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?
abstract: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the intensive care unit (ICU). Patients with type 2 diabetes mellitus (T2DM) are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients.
  
  
  
  This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS) until ICU discharge, VAP diagnosis, or death.
  
  
  
  Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27-31.9). The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57). Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR): 10.12 [95% confidence interval (CI): 5.1-20.2);P< 0.0001)].
  
  
  
  The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.
authors.affiliation: Department of Nursing, Sari Branch, Islamic Azad University, Sari, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Darvishi-Khezri
authors.affiliation: Department of Community Medicine, Thalassemia Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Alipour
authors.affiliation: Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Emami Zeydi
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Firouzian
authors.affiliation: Hospital Management Research Centers, Department of Health Services Management, Sari Branch, Islamic Azad University, Sari, Iran.
authors.forename: Ghahraman
authors.initials: G
authors.lastname: Mahmudi
authors.affiliation: Department of Infectious Diseases, Sari Branch, Islamic Azad University, Sari, Iran.
authors.forename: Melody
authors.initials: M
authors.lastname: Omrani-Nava
keywords: Diabetes mellitus; intensive care unit (ICU); trauma; ventilator-associated pneumonia (VAP)