Enterobacteria-Related Bacteremia Increased for Diabetics

Patients with diabetes face a higher risk for community-acquired bacteremia due to enterobacteria than do non-diabetics, Danish researchers have found. "Diabetic persons with signs and symptoms of urinary tract infection or bacteremia/sepsis should be told to seek medical care promptly," Dr. Reimar W. Thomsen said, "and physicians should keep a high level of suspicion for these infections if the patient has diabetes."

Dr. Thomsen from Aarhus University Hospital in Aalborg, Denmark, and colleagues examined diabetes as a risk factor for community-acquired bacteremia due to enterobacteria, and investigated whether diabetes was associated with poor outcomes, in a case-control study involving 1317 bacteremic patients matched with 10 population controls per case.

The greatest relative risk, nearly 6-fold higher, was seen in patients under 65 years old, the results indicate, and the relative risk was higher for diabetic female subjects than for diabetic male subjects.

Also, 30-day mortality was higher among diabetics (17.3%) than non-diabetics (13.4%), the researchers found, and the disparity persisted after 90 days (23.6% versus 19.5%, respectively).

"We conclude that diabetes has a considerable public health impact on the risk for and prognosis of enterobacterial bacteremia acquired in the community," the investigators write. "Preventive measures for diabetic patients might include increased surveillance and avoidance of well-known risk factors for urinary tract infections."

As Dr. Thomsen commented, "Prompt and appropriate antibiotic therapy, eradication of foci of infection when possible, stabilization of blood pressure, and more specialized intensive care treatment when severe sepsis is present is important for all patients with bacteremia, diabetic or nondiabetic."

However, he continued, "Hyperglycemic derangement is a special risk for diabetic patients with severe infection and should be treated early and intensively."

The group is currently investigating diabetes and mortality in different types of bacteremia, Dr. Thomsen added. "An important issue for further studies will be the influence of long-term hyperglycemic control on both risk and prognosis of infection."
Clin Infect Dis 2005;40:628-631.

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