Ashok Kumar Pannu1, Atul Saroch2, Vidhi Singla3, Navneet Sharma4, Pinaki Dutta5, Arihant Jain6, Archana Angrup7. 1. Department of Internal Medicine, PGIMER, Chandigarh, India. Electronic address: gawaribacchi@gmail.com. 2. Department of Internal Medicine, PGIMER, Chandigarh, India. Electronic address: atulsaroch@gmail.com. 3. Department of Internal Medicine, PGIMER, Chandigarh, India. Electronic address: vidhi131289@gmail.com. 4. Department of Internal Medicine, PGIMER, Chandigarh, India. Electronic address: navneetsharma@hotmail.com. 5. Department of Endocrinology, PGIMER, Chandigarh, India. Electronic address: pinakidutta1000@gmail.com. 6. Department of Internal Medicine, PGIMER, Chandigarh, India. Electronic address: drarihantjain86@gmail.com. 7. Department of Medical Microbiology, PGIMER, Chandigarh, India. Electronic address: archanaangrup@yahoo.com.
Abstract
BACKGROUND AND AIMS: The patients with diabetes mellitus (DM) have an increased incidence of both common and unusual infections. Despite an increasing prevalence of DM in India, local data on the epidemiology and clinical spectrum of associated infections are lacking. We aimed to investigate the spectrum, etiology, and outcome of infectious disorders in adult patients with DM admitted in a medical emergency. METHODS: A single-center retrospective observational study conducted between January 2018 to June 2019 in a tertiary care hospital in north India. Based on clinical presentation, radiological features, and microbiological or pathological evidence, 152 diabetic patients aged 12 years and above were diagnosed with the infectious syndrome. RESULTS: Urinary tract infection was the most prevalent infectious syndrome (32.2%), followed by pneumonia and empyema (26.3%), skin and soft tissue infections (6.6%), sepsis of unknown primary source (6.6%), pulmonary tuberculosis (4.6%), rhinocerebral infections (4.6%), infectious diarrhea (3.9%), and viral encephalitis (2.6%). The majority of the infections were community-acquired (94.7%). 80.3% of study cases had type 2 DM. The common presenting symptoms were fever (46.1%), dyspnea (27.6%), and altered sensorium (25.7%). Shock and diabetic ketoacidosis were frequent, and each was seen in 27.6% of cases. The mortality rate was 27.6% and was higher with sepsis of unrecognized source (50.0%) and lung infections (30.0%). The presence of shock was the independent predictor of mortality on a multivariant analysis (p-value 0.000). CONCLUSIONS: Urinary tract and lung infections remain common in DM. Establishing a microbiological etiology and identification of the source are necessary steps to reduce mortality.
BACKGROUND AND AIMS: The patients with diabetes mellitus (DM) have an increased incidence of both common and unusual infections. Despite an increasing prevalence of DM in India, local data on the epidemiology and clinical spectrum of associated infections are lacking. We aimed to investigate the spectrum, etiology, and outcome of infectious disorders in adult patients with DM admitted in a medical emergency. METHODS: A single-center retrospective observational study conducted between January 2018 to June 2019 in a tertiary care hospital in north India. Based on clinical presentation, radiological features, and microbiological or pathological evidence, 152 diabeticpatients aged 12 years and above were diagnosed with the infectious syndrome. RESULTS: Urinary tract infection was the most prevalent infectious syndrome (32.2%), followed by pneumonia and empyema (26.3%), skin and soft tissue infections (6.6%), sepsis of unknown primary source (6.6%), pulmonary tuberculosis (4.6%), rhinocerebral infections (4.6%), infectious diarrhea (3.9%), and viral encephalitis (2.6%). The majority of the infections were community-acquired (94.7%). 80.3% of study cases had type 2 DM. The common presenting symptoms were fever (46.1%), dyspnea (27.6%), and altered sensorium (25.7%). Shock and diabetic ketoacidosis were frequent, and each was seen in 27.6% of cases. The mortality rate was 27.6% and was higher with sepsis of unrecognized source (50.0%) and lung infections (30.0%). The presence of shock was the independent predictor of mortality on a multivariant analysis (p-value 0.000). CONCLUSIONS: Urinary tract and lung infections remain common in DM. Establishing a microbiological etiology and identification of the source are necessary steps to reduce mortality.