Is type 2 diabetes mellitus in mechanically ventilated adult trauma patients potentially related to the occurrence of ventilator-associated pneumonia?

Abstract

Background:Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the intensive care unit (ICU). Patients with type 2 diabetes mellitus (T2DM) are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients.Materials and Methods:This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS) until ICU discharge, VAP diagnosis, or death.Results:Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27–31.9). The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57). Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR): 10.12 [95% confidence interval (CI): 5.1–20.2); P < 0.0001)].Conclusion:The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.

Prevalence Rate of Diabetes and Hypertension in Disaster-Exposed Populations: A Systematic Review and Meta-Analysis

“…The reported prevalence rate regarding DM varies around the world. Various studies have estimated the number of people with DM worldwide from 451 million in 2017 to 592 million in 2035 ( 22 – 23 ). Type 1 DM can occur at any age, but its highest incidence is at birth to age 14 ( 24 ).…”

“…Environmental factors play an important role in transforming a brief autoimmunity into type 1 DM. Improvement of living standards and reduction of exposure to microorganisms are likely to result in rise of autoimmunity ( 23 , 25 ). Type 2 DM has a slow onset, and unlike type 1, its common symptoms lack any kind of acute metabolic disorder.…”

“…Type 2 DM has a slow onset, and unlike type 1, its common symptoms lack any kind of acute metabolic disorder. In type 2 DM, there is a long pre-diagnosis period that more than half of cases could be left unnoticed ( 23 ).…”

Sex Differences in Hospital-Acquired Pneumonia among Patients with Type 2 Diabetes Mellitus Patients: Retrospective Cohort Study using Hospital Discharge Data in Spain (2016–2019)

“…In the current study, we showed that VAP increased the OR of dying in both men and women with T2DM. Previous studies also reported that T2DM is associated with increased mortality rates in VAP patients [ 38 , 39 ]. The several factors that could explain the higher rates of mortality in T2DM patients with VAP include older age and more frequent comorbidity, which increase vulnerability to severe complications, such as organ failure, and lead to earlier and more frequent death [ 31 ].…”

Pneumonia in Trauma Patients

“…Unmodifiable risk factors that predispose trauma patients to pneumonia can be considered in terms of patient factors and injury factors (Table 1). Patient factors that are independent risk factors for the development of pneumonia among trauma patients include increasing age [11, 12, 13•], male gender [12], cardiac disease [12], COPD [1,11], type II diabetes mellitus [14], cancer [12], and immunosuppression [1]. There are multiple injury factors that increase risk for pneumonia.…”