Journal Article Ahead of print
PubMed: 41077620 DOI: 10.1007/s15010-025-02659-w
Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study.
Infection
Authors: Belén Millet Pascual-Leone, Facundo Fiocca Vernengo, David Hillus, Charlotte Wernicke, Gopinath Krishnamoorthy, Jan Rupp, Gernot Rohde, Mathias W Pletz, Martin Witzenrath, Norbert Suttorp, Leif Erik Sander, Andreas Vestergaard Jensen, Bastian Opitz, Charlotte Thibeault
Affiliations
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- CAPNETZ Stiftung, Hannover, Germany.
- Infectious Diseases Clinic and Institute of Medical Microbiology, University Hospital Schleswig-Holstein, Luebeck, Germany.
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
- Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
- German Center for Lung Research (DZL), Berlin, Germany.
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
PURPOSE
Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM-) patients in a European CAP cohort.
METHODS
Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002-2022, with and without a history of DM, were conducted.
RESULTS
Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM- patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31-202) vs. 86 mg/L (IQR: 24-190), p < 0.0001; median leucocyte count 12/nl (IQR: 9-16)vs. 11/nl (IQR: 8-15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM- patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), p adj < 0.01).
CONCLUSIONS
CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.
MeSH
Diabetes Mellitus, Cohort Studies, Pneumonia, History, Infections, Community-Acquired Pneumonia