PURPOSE: Diabetes Mellitus is an immunosuppressive state leading to increased susceptibility to various infections including pneumonia. Pneumonia in diabetic patients is often atypical, caused by more virulent organisms and associated with increased antibiotic resistance.
METHODS: It was an observational study conducted in the Department of Internal Medicine & Pulmonology of BIRDEM Hospital, Dhaka, Bangladesh, (WHO collaborative 600 bedded tertiary care hospital for diabetic patients), from January 2008 to December 2009. A total of 122 hospitalized diabetic patients with community acquired pneumonia were taken in the study.
RESULTS: Out of 122 subjects, 82 (67%) were male, 40 (33%) were female. Mean age of the patients was - 60.79 ±11.5 years. Mean duration of diabetes was - 7.33 ±1.2 years. Sputum for culture shows that out of 122 (100%) patients, Klebsiella pneumonia was detected in 54 (44.3%) patients, Pseudomonas in 16 (13.1%) patients, E.coli in 10 (8.2%) patients, Staphylococcus aureus in 18 (14.8%), Acinetobacter in 10 (8.2) and 14 (12%) patients had growth of other organisms. Sputum pus cell was significant in 64 (52.5%) samples. Antibiotic sensitivity pattern shows that among 54 (100%) growth of Klebsiella, Ceftriaxone was 10 (18.5%) sensitive vs 44 (81.5%) resistant, Ceftazidime was 14 (25.9%) sensitive vs 40 (74.1%) resistant [ p= 0.040], Amikacin was 40 (74.1%) sensitive vs 14 (25.9%) resistant [p= 0.035], Imipenem was 52 (96.3%) sensitive vs 2 (3.7%) resistant [p= 0.000], Ciprofloxacin was 26 (48.1%) sensitive vs 28 (51.9%) resistant. Mean HbA1c was - 8.6 ±1.89. Correlation with growth of organism shows that 52 (96.3%) of Klebsiella growth occurred with HbA1c > 7.
CONCLUSION: The above results suggest that community acquired pneumonia in uncontrolled diabetic patients are more frequently due to Klebsiella, Pseudomonas and S. aureus and frequently they are resistant to Ceftriaxone and oral antibiotics.
CLINICAL IMPLICATIONS: So, empirical treatment of diabetic pneumonia with Ceftriaxone or oral antibiotic is not a good option and alternative antibiotics should be used.
DISCLOSURE: Mohammad Hossain, No Financial Disclosure Information; No Product/Research Disclosure Information