Dourliou Vasiliki, Kakaletsis Nikolaos, Stamou Dafni, Champla Antigoni, Tsakiri Kalliopi, Agapakis Dimitrios, Didangelos Triantafyllos
Department of Adult Intensive Care Unit, Ippokrateio General Hospital, 54642 Thessaloniki, Greece.
Internal Medicine Unit, Ippokrateio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Diagnostics (Basel). 2025 May 8;15(10):1190. doi: 10.3390/diagnostics15101190.
Diabetes mellitus (DM) is an independent risk factor for severe SARS-CoV-2 infection and is linked to higher incidences of infections and adverse outcomes in patients with DM. This study examines the association between DM and multidrug-resistant Gram-negative bacteria (MDR-GNB) in critically ill, intubated COVID-19 patients in the intensive care unit (ICU) and evaluates mortality rates and clinical factors contributing to unfavorable outcomes. This retrospective observational study included intubated COVID-19 patients diagnosed with secondary infections due to MDR-GNB. Patients were treated for acute respiratory distress syndrome (ARDS) in a tertiary care university hospital ICU between October 2020 and February 2022. Collected data included demographics, comorbidities, medication, and laboratory parameters including blood tests and culture samples. Among 416 COVID-19 patients, 112 (26.9%) had T2DM. Cultures from lower respiratory tract specimens revealed a significantly higher likelihood of isolating in patients with DM (OR: 2.18, 95% CI: 1.40-3.40, < 0.001), and DM is an independent predictor of isolation in bronchial secretions of COVID-19 intubated patients (OR: 2.046, 95% CI: 1.256-3.333. < 0.004). DM was not significantly associated with differences in length of stay (LOS) until discharge or death (HR: 0.76, 95% CI: 0.51-1.12, = 0.16; HR: 0.91, 95% CI: 0.70-1.19, = 0.50) or 28-day ICU mortality (OR: 1.12, 95% CI: 0.52-2.41, = 0.77). Age was linked to an increased 28-day mortality risk in patients with DM (OR: 1.10, 95% CI: 1.02-1.18, = 0.011). In critically ill intubated COVID-19 patients, DM emerged as a significant and independent predictor for the isolation of from bronchial secretions, highlighting a key link between DM and specific multidrug-resistant pathogens, even though no broader association with MDR-GNB-related secondary infections was observed.
糖尿病（DM）是严重的2019冠状病毒病（SARS-CoV-2）感染的独立危险因素，并且与糖尿病患者感染及不良结局的较高发生率相关。本研究调查了重症监护病房（ICU）中插管的危重症2019冠状病毒病（COVID-19）患者的糖尿病与多重耐药革兰氏阴性菌（MDR-GNB）之间的关联，并评估死亡率以及导致不良结局的临床因素。这项回顾性观察性研究纳入了因MDR-GNB诊断为继发感染的插管COVID-19患者。2020年10月至2022年2月期间，患者在一家三级大学医院ICU接受急性呼吸窘迫综合征（ARDS）治疗。收集的数据包括人口统计学资料、合并症、用药情况以及实验室参数，包括血液检查和培养样本。在416例COVID-19患者中，112例（26.9%）患有2型糖尿病（T2DM）。下呼吸道标本培养显示，糖尿病患者分离出[具体细菌名称未给出]的可能性显著更高（比值比：2.18，95%置信区间：1.40 - 3.40，P < 0.001），并且糖尿病是COVID-19插管患者支气管分泌物中分离出[具体细菌名称未给出]的独立预测因素（比值比：2.046，95%置信区间：1.256 - 3.333，P < 0.004）。糖尿病与出院或死亡前的住院时间（LOS）差异无显著关联（风险比：0.76，95%置信区间：0.51 - 1.12，P = 0.16；风险比：0.91，95%置信区间：0.70 - 1.19，P = 0.50），也与28天ICU死亡率无显著关联（比值比：1.12，95%置信区间：0.52 - 2.41，P = 0.77）。年龄与糖尿病患者28天死亡风险增加相关（比值比：1.10，95%置信区间：1.02 - 1.18，P = 0.011）。在危重症插管COVID-19患者中，糖尿病成为支气管分泌物中分离出[具体细菌名称未给出]的显著且独立预测因素，突出了糖尿病与特定多重耐药病原体之间的关键联系，尽管未观察到与MDR-GNB相关继发感染的更广泛关联。
