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Purpose <p>Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM−) patients in a European CAP cohort.</p> Methods <p>Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002–2022, with and without a history of DM, were conducted.</p> Results <p>Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM− patients, DM+ patients had a higher 180&#xa0;days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), <i>p</i> &lt; 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97&#xa0;mg/L (IQR: 31–202) vs. 86&#xa0;mg/L (IQR: 24–190), <i>p</i> &lt; 0.0001; median leucocyte count 12/nl (IQR: 9–16)vs. 11/nl (IQR: 8–15), <i>p</i> &lt; 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM− patients (<i>p</i> = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), <i>p</i><sub>adj</sub> &lt; 0.01).</p> Conclusions <p>CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.</p>

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Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study

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  • 发表日期：

    2025年10月12日

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  • Belén Millet Pascual-Leone,
  • Facundo Fiocca Vernengo,
  • David Hillus,
  • Charlotte Wernicke,
  • Gopinath Krishnamoorthy,
  • Jan Rupp,
  • Gernot Rohde,
  • Mathias W. Pletz,
  • Martin Witzenrath,
  • A. Fuchs,
  • G. Paul,
  • M. Ayoub,
  • A. Prasse,
  • W. Bauer,
  • E. C. Diehl-Wiesenecker,
  • N. Galtung,
  • C. Kodde,
  • Y.-M. Stoppe,
  • C. Boesecke,
  • S. Breitschwerdt,
  • D. Benke,
  • S. Schmager,
  • A. Grünewaldt,
  • J. Wheeler,
  • B. Schaaf,
  • J. Kremling,
  • M. Kolditz,
  • B. Schulte-Hubbert,
  • J. Ronczka,
  • A. Seeger,
  • J. Kohlhäufl,
  • D. Stolz,
  • S. Fähndrich,
  • M. Panning,
  • M. Unnewehr,
  • R. Lim,
  • M. Hoeper,
  • I. Pink,
  • N. Drick,
  • T. Fühner,
  • T. Steinberg,
  • G. Barten-Neiner,
  • W. Kröner,
  • O. Unruh,
  • N. Adaskina,
  • F. Eberhardt,
  • T. Illig,
  • N. Klopp,
  • B. T. Schleenvoigt,
  • A. Moeser,
  • D. Drömann,
  • P. Parschke,
  • K. Franzen,
  • F. Waldeck,
  • B. Gebel,
  • N. Käding,
  • S. Boutin,
  • J. Schneider,
  • J. Erber,
  • F. Voit,
  • D. Heigener,
  • I. Hering,
  • W. Albrich,
  • F. Rassouli,
  • B. Wirth,
  • C. Neurohr,
  • A. Essig,
  • S. Stenger,
  • M. Wallner,
  • H. Burgmann,
  • L. Traby,
  • L. Schubert,
  • Norbert Suttorp,
  • Leif Erik Sander,
  • Andreas Vestergaard Jensen,
  • Bastian Opitz,
  • Charlotte Thibeault

摘要

Purpose

Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM−) patients in a European CAP cohort.

Methods

Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002–2022, with and without a history of DM, were conducted.

Results

Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM− patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31–202) vs. 86 mg/L (IQR: 24–190), p < 0.0001; median leucocyte count 12/nl (IQR: 9–16)vs. 11/nl (IQR: 8–15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM− patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), padj < 0.01).

Conclusions

CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.