Department of Internal Medicine, PGIMER, Chandigarh, India.
Department of Endocrinology, PGIMER, Chandigarh, India.
Diabetes Metab Syndr. 2020 Sep-Oct;14(5):921-925. doi: 10.1016/j.dsx.2020.06.004. Epub 2020 Jun 12.
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.
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.
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).
Urinary tract and lung infections remain common in DM. Establishing a microbiological etiology and identification of the source are necessary steps to reduce mortality.
糖尿病（DM）患者的常见和不常见感染发病率均增加。尽管印度的 DM 患病率不断上升，但缺乏有关相关感染的流行病学和临床谱的本地数据。我们旨在调查在一家医疗急救中心住院的成年糖尿病患者的感染性疾病谱、病因和结局。
这是一项在印度北部一家三级保健医院进行的单中心回顾性观察性研究。根据临床表现、影像学特征以及微生物学或病理学证据，诊断出 152 名年龄在 12 岁及以上的患有感染综合征的糖尿病患者。
尿路感染是最常见的感染综合征（32.2%），其次是肺炎和脓胸（26.3%）、皮肤和软组织感染（6.6%）、不明原因的血源性感染（6.6%）、肺结核（4.6%）、鼻颅感染（4.6%）、感染性腹泻（3.9%）和病毒性脑炎（2.6%）。大多数感染为社区获得性感染（94.7%）。80.3%的研究病例为 2 型糖尿病。常见的首发症状是发热（46.1%）、呼吸困难（27.6%）和意识改变（25.7%）。休克和糖尿病酮症酸中毒很常见，各占 27.6%的病例。死亡率为 27.6%，原因不明的败血症（50.0%）和肺部感染（30.0%）的死亡率更高。在多变量分析中，休克的存在是死亡的独立预测因素（p 值<0.000）。
尿路感染和肺部感染在 DM 中仍然很常见。建立微生物病因学和确定感染源是降低死亡率的必要步骤。
