title: Incidence, characteristic and outcomes of ventilator-associated pneumonia among type 2 diabetes patients: An observational population-based study in Spain.
abstract: BACKGROUND
  To describe incidence, characteristics and outcomes of ventilator-associated pneumonia (VAP) during hospitalization among patients with or without type 2 diabetes (T2DM).
  
  
  METHODS
  We used the Spanish national hospital discharge database to select all hospitalization with VAP in subjects aged 40years or more from 2010 to 2014. We analyzed incidence, patient comorbidities, procedures, pneumonia pathogens and in-hospital outcomes according to diabetes status (T2DM and no-diabetes). We used propensity score analysis to estimate the effect of T2DM on in-hospital mortality RESULTS: In 7952 admissions, the patient developed a VAP (13.6% with T2DM). Adjusted incidence rate of VAP was slightly, but significantly, higher in T2DM than in non-diabetic patients (36.46[95% CI 34.41-38.51] vs. 32.57[95% CI 31.40-33.74] cases per 100,000/inhabitants). T2DM people were older and had higher Charlson comorbidity index than non-diabetic people. T2DM patients had a lower mean number of failing organs than non-diabetic patients (1.20 SD 1.17 vs. 1.45 SD 1.44, p<0.001). Pseudomonas was the most frequently isolated agent in both groups. IHM was 41.92% for T2DM patients and 37.91% for non-diabetic patients (p<0.05). Factors associated with a higher mortality in both groups included: older age, more comorbidities and primary diagnoses of vein or artery occlusion, pulmonary disease and cancer. T2DM was not associated with a higher in-hospital mortality after adjustment using a propensity score (OR 0.88; 95% CI 0.76-1.35).
  
  
  CONCLUSIONS
  VAP incidence rates were higher among T2DM patients. In-hospital mortality was higher among the older patients and those with more co-morbid conditions. T2DM does not predict higher mortality in VAP during hospitalization.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jiménez-Trujillo
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain. Electronic address: rodrigo.jimenez@urjc.es.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
authors.affiliation: Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Comunidad de Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel-Díez
authors.affiliation: Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Comunidad de Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de Miguel-Yanes
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Comunidad de Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Méndez-Bailón
authors.affiliation: Health Security Agency, Ministry of Health, Social Services and Equality, Madrid, Comunidad de Madrid, Spain.
authors.forename: Napoleón
authors.initials: N
authors.lastname: Pérez-Farinós
authors.affiliation: Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain.
authors.forename: Miguel-Ángel
authors.initials: MÁ
authors.lastname: Salinero-Fort
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Comunidad de Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: López-de-Andrés
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology
keywords: Hospitalization; In-hospital mortality; Type 2 diabetes; Ventilator-associated pneumonia