Community-Acquired Pneumonia in Elderly Patients With Diabetes Mellitus

BackgroundBoth diabetes mellitus (DM) and community-acquired pneumonia (CAP) are prevalent in elderly and are associated with significant morbidity and mortality. The primary objective of this subgroup analysis was to determine risk factors of the inhospital mortality, complication rate, and prolonged length of hospital stay (LOS) of CAP in elderly diabetic patients hospitalized with CAP.MethodsA retrospective cohort study of 157 elderly diabetic patients hospitalized with CAP at 2 tertiary teaching hospitals was carried out. Multivariate logistic and cox regression analyses were used to assess risk factors associated with inhospital mortality, complications, and LOS.ResultsDuring the follow-up period from admission till discharge, 30 (19.1%) patients died and 66 (42%) had complications. Seventeen (56.67%) of the patients who died received their first dose of appropriate antibiotic for CAP longer than 8 hours since triage, whereas 26 (20.47%) of survived patients received their first dose longer than 8 hours of triage at emergency department (ED) (P = <0.0001). Thirteen of 114 (11.4%) patients who received their first appropriate antibiotics in 8 hours or less since triage at ED died, whereas 17 of 43 (39.5%) patients who received their first appropriate antibiotics longer than 8 hours since triage died (P = <0.0001). In the multivariate analysis, time to first dose of appropriate antibiotic therapy longer than 8 hours since triage was associated with increased inhospital mortality (odds ratio, 5.94; 95% confidence interval [95% CI], 2.02–17.43; P = 0.001), complications (odds ratio, 2.90; 95% CI, 1.24–6.79; P = 0.01), and prolonged LOS of CAP (hazard ratio, 0.36; 95% CI, 0.20–0.65; P = 0.001).ConclusionsTime to first dose of appropriate antibiotic therapy longer than 8 hours since triage at ED might be associated with increased morbidity and mortality of CAP in elderly patients with diabetes mellitus.