Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection

DONG Lin; WANG De-bin; LEI Zu-bao; ZHAO Lei; XU Ping; YANG Wan-chun

doi:10.16462/j.cnki.zhjbkz.2020.11.012

Volume 24 Issue 11

Dec. 2020

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DONG Lin, WANG De-bin, LEI Zu-bao, ZHAO Lei, XU Ping, YANG Wan-chun. Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(11): 1302-1307，1314. doi: 10.16462/j.cnki.zhjbkz.2020.11.012

Citation:

DONG Lin, WANG De-bin, LEI Zu-bao, ZHAO Lei, XU Ping, YANG Wan-chun. Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(11): 1302-1307，1314. doi: 10.16462/j.cnki.zhjbkz.2020.11.012

Citation:

DONG Lin, WANG De-bin, LEI Zu-bao, ZHAO Lei, XU Ping, YANG Wan-chun. Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(11): 1302-1307，1314. doi: 10.16462/j.cnki.zhjbkz.2020.11.012

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Risk factors and pathogen characteristics of adult type 2 diabetes mellitus patients with community-onset bloodstream infection

doi: 10.16462/j.cnki.zhjbkz.2020.11.012

1.
Department of Respiratory and Critical Diseases, the Second People's Hospital of Hefei, Hefei 230011, China
2.
Department of Health Information, School of Health Management, Anhui Medical University, Hefei 230011, China

Funds:

National Natural Science Foundation of China 81861138049

Research Fund of Anhui Medical University 2019xkj085

More Information

Corresponding author: YANG Wan-chun, E-mail:1225399339@qq.com
Received Date: 2020-05-08
Rev Recd Date: 2020-07-14
Publish Date: 2020-11-10

Abstract

Abstract

Objective To analyze the risk factors and pathogen characteristics of adult type 2 diabetes mellitus (T2DM) patients with community-onset bloodstream infection (COBSI) risk, so as to provide theoretical basis for early diagnosis and treatment. Methods A total of 293 T2DM inpatients who were admitted to the Second People's Hospital of Hefei from the adult community during 2017/01-2020/03 were retrospectively analyzed, which were divided into bloodstream infection (BSI) group and control group according to the blood results within 48 hours. Based on the analysis of the risk factors, prediction model and test model were constructed. The characteristics of pathogenic bacteria was analyzed on community acquired bloodstream infection (CABSI) group and health care-associated community acquired bloodstream infection (HCABSI) group. Results The prediction model was established. P=1/(1+e^-y), y=-45.137+0.751×peak body temperature outside the hospital or within 48 h of admission+0.033×neutrophil percentage+0.027×plasma osmotic pressure+0.009×blood C-reactive protein+1.144×kidney failure+1.740×diabetic ketoacidosis. The area under a curve (AUC) of the model was 0.800, 95% CI was from 0.747 to 0.853, and the optimal cutoff value was 0.208 and the sensitivity was 0.90, specificity was 0.56. Hosmer-lemeshow test was performed for the calibration degree of the model, χ²=12.285, P=0.139. There were statistically significant differences (all P < 0.05) between CABSI and HCABSI groups in Gram-negative bacteria (G^-), extended-spectrum β-lactamases-producing Escherichia coli, Escherichia coli, Gram-positive bacteria (G⁺) and Staphylococcus aureus. Conclusions Peak body temperature outside the hospital or within 48 hours of admission, neutrophil percentage, plasma osmotic pressure, serum C-reactive protein, kidney failure, and diabetic ketoacidosis are risk factors for COBSI in adult T2DM patients. The prediction model has good sensitivity, and there are differences in pathogenic bacteria between CABSI and HCABSI groups, which has clinical guiding significance for early diagnosis and treatment.
- Diabetes,
- Type 2,
- Bloodstream infection,
- Risk factors,
- Pathogenic bacteria

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References(14)

References

[1]	Wang LM, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24):2515-2523. DOI: 10.1001/jama.2017.7596.
[2]	梁蓓, 姜利, 刘淑梅, 等.首都医科大学附属复兴医院2012年住院患者血流感染分析[J].中华内科杂志, 2016, 55(8):609-612. DOI: 10.3760/cma.j.issn.0578-1426.2016.08.008. Liang B, Jiang L, Liu SM, et al. The epidemiology of bloodstream infections in fuxing hospital in 2012 in Beijing[J]. Chin J Intern Med, 2016, 55(8):609-612. DOI: 10.3760/cma.j.issn.0578-1426.2016.08.008.
[3]	Hoenigl H, Wagner J, Raggam RB, et al. Characteristics of hospital-acquired and community-onset bloodstream infections, South-East Austria[J]. PLoS One, 2014, 9(8):e104702. DOI: 10.1371/journal.pone.0104702.
[4]	Friedman ND, Kaye KS, Stout JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections[J]. Ann Intern Med, 2002, 137(10):791-797. DOI: 10.7326/0003-4819-137-10-200211190-00007.
[5]	中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志, 2018, 10(1):4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003. Chinese Diabetes Society. Chinese guideline for the prevention and treatment of type 2 diabetes mellitus (2017 edition)[J]. Chin J Diabetes Mellitus, 2018, 10(1):4-67. DOI: 10.3760/cma.j.issn.1674-5809.2018.01.003.
[6]	中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志, 2001, 81(5):314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027. Ministry of Health of the People's Republic of China. Diagnostic criteria for nosocomial infections (for trial implementation)[J]. Natl Med J China, 2001, 81(5):314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027.
[7]	中华医学会检验医学分会.临床微生物学血培养操作规范[J].中华检验医学杂志, 2004, 27(2):124-126. DOI: 10.3760/j:issn:1009-9158.2004.02.025. Chinese Society of Laboratory Medicine. Diagnostic criteria for nosocomial infections (for trial implementation)[J]. Chin J Lab Med, 2004, 27(2):124-126. DOI: 10.3760/j:issn:1009-9158.2004.02.025.
[8]	Donnelly JP, Nair S, Griffin R, et al. Association of diabetes and insulin therapy with risk of hospitalization for Infection and 28-Day mortality risk[J]. Clin Infect Dis, 2017, 64(4):435-442. DOI: 10.1093/cid/ciw738.
[9]	Takeshita N, Kawamura I, Kurai H, et al. Unique characteristics of community-onset healthcare-associated bloodstream infections: a multi-centre prospective surveillance study of bloodstream infections in Japan[J]. J Hosp Infect, 2017, 96(1):29-34. DOI: 10.1016/j.jhin.2017.02.022.
[10]	Abu-Ashour W, Twells LK, Valcour JE, et al. Diabetes and the occurrence of infection in primary care: a matched cohort study[J]. BMC Infect Dis, 2018, 18(1):67. DOI: 10.1186/s12879-018-2975-2.
[11]	Leisman DE, Doerfler ME, Schneider SM, et al. Predictors, prevalence, and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock[J]. Critical Care Medicine, 2018, 46(2):189-198. DOI: 10.1097/CCM.0000000000002834.
[12]	潘亚萍, 沈继录, 徐元宏, 等.不同感染性指标在血流感染早期诊断中的应用价值[J].中国感染与化疗杂志, 2016, 16(5):571-577. DOI: 10.16718/j.1009-7708.2016.05.008. Pan YP, Shen JL, Xu YH, et al. Utility of procalcitonin, C-reactive protein, white blood cell count, neutrophils count and percentage in early diagnosis of bloodstream infection[J]. Clin J Infect Chemother, 2016, 16(5):571-577. DOI: 10.16718/j.1009-7708.2016.05.008.
[13]	Pan YP, Fang YP, Xu YH, et al. The diagnostic value of procalcitonin versus other biomarkers in prediction of bloodstream infection[J]. Clin Lab, 2017, 63(2):277-285. DOI: 10.7754/Clin.Lab.2016.160802.
[14]	Anderson DJ, Moehring RW, Sloane R, et al. Bloodstream infections in community hospitals in the 21st century: A multicenter cohort study[J]. PLoS One, 2014, 9(3):e91713. DOI: 10.1371/journal.pone.0091713.