Incidence and Predictors of Hospitalization for Bacterial Infection in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study

Abstract

BackgroundThe few studies that have examined the relationship between diabetes and bacterial infections have utilized administrative databases and/or have had limited/incomplete data including recognized infection risk factors. The aim of this study was to determine the incidence and associates of bacterial infection severe enough to require hospitalization in well-characterized community-based patients with type 2 diabetes.Methods and FindingsWe studied a cohort of 1,294 patients (mean±SD age 64.1±11.3 years) from the longitudinal observational Fremantle Diabetes Study Phase I (FDS1) and 5,156 age-, gender- and zip-code-matched non-diabetic controls. The main outcome measure was incident hospitalization for bacterial infection as principal diagnosis between 1993 and 2010. We also examined differences in statin use in 52 FDS1 pairs hospitalized with pneumonia (cases) or a contemporaneous non-infection-related cause (controls). During 12.0±5.4 years of follow-up, 251 (19.4%) patients were hospitalized on 368 occasions for infection (23.7/1,000 patient-years). This was more than double the rate in matched controls (incident rate ratio (IRR) (95% CI), 2.13 (1.88–2.42), P<0.001). IRRs for pneumonia, cellulitis, and septicemia/bacteremia were 1.86 (1.55–2.21), 2.45 (1.92–3.12), and 2.08 (1.41–3.04), respectively (P<0.001). Among the diabetic patients, older age, male sex, prior recent infection-related hospitalization, obesity, albuminuria, retinopathy and Aboriginal ethnicity were baseline variables independently associated with risk of first hospitalization with any infection (P≤0.005). After adjustment for these variables, baseline statin treatment was not significant (hazard ratio (95% CI), 0.70 (0.39–1.25), P = 0.22). Statin use at hospitalization for pneumonia among the case-control pairs was similar (23.1% vs. 13.5%, P = 0.27).ConclusionsThe risk of severe infection is increased among type 2 diabetic patients and is not reduced by statin therapy. There are a number of other easily-accessible sociodemographic and clinical variables that could be used to optimize infection-related education, prevention and management in type 2 diabetes.

Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections

“…Only herpes simplex virus infection, mastoiditis, human immunodeficiency virus infection and appendicitis did not occur more frequently in patients with diabetes mellitus[13]. These findings were confirmed by Hamilton et al in a prospective cohort study in Australia, with risk of hospitalization for an infection increased two-fold among patients with diabetes mellitus (incident rate ratio = 2.13; 95% CI 1.88-2.42)[14]. In a Danish population, Benfield et al found that patients withTABLE 1.…”

“…Almost half of the patients with diabetes had at least one hospitalization or physician claim for an infectious disease during the study year (risk ratio (RR) = 1. 21 [13][14][15] diabetes mellitus were three times as likely as patients without diabetes mellitus to be hospitalized for an infection (hazard ratio = 3.05; 95% CI 2.47-3.78) [15]. In addition to being at greater risk of developing various infections, patients with diabetes mellitus are at high risk of mortality when such infections occur.…”

Metformin and other glucose-lowering drug initiation and rates of community-based antibiotic use and hospital-treated infections in patients with type 2 diabetes: a Danish nationwide population-based cohort study

“…24 Hyperglycaemia may be a risk factor for infections in patients with type 2 diabetes. [26][27][28][29][30] Therefore, GLDs in theory might influence risk of infections via their different glucose-lowering mechanisms and effectiveness. Hyperglycaemia seems to weaken innate immunity via its negative influence on polymorphonuclear neutrophil function and intracellular bactericidal and opsonic activity.…”

Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study

“…(1) The association between diabetes (DM) and infection is well known clinically, (2; 3), and has been linked to a number of causal pathways including impaired immune responses within the hyperglycaemic environment (4), as well as potentially other abnormalities associated with diabetes such as neuropathy and altered lipid metabolism. It has been described in other studies and populations, (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) however not all have consistently controlled for confounding factors such as smoking, which are more common in people with diabetes and associated with infection. (18) Initially, studies mainly considered predominately common infections, (6; 8; 12) with few able to include important but rare infections,(7) such as endocarditis, or considered the whole range of infection outcomes from health service use, (17) to hospitalisation (16) and mortality.…”