European Journal of Cardiovascular Medicine

Introduction: Infections of respiratory tract are perhaps the most common human ailments. They are the source of discomfort, disability and loss of many work days for most adults. They lead to substantial morbidity and mortality in young children and elderly. Among the respiratory infections, pneumonia is a common cause of hospital admission, although a majority are treated in out-patient settings. Pneumonia presents as a challenge to physicians, have to decide on therapy without the benefit of definitive etiological diagnosis as the clinical features of pneumonia are neither sensitive nor reliable guide in permitting an etiological diagnosis. Diabetes mellitus is a very prevalent chronic metabolic disorder that is present in about 5-10% of elderly population. Several aspects of immunity such as polymorphonuclear leukocyte function i.e., leukocyte adherence, chemotaxis, phagocytosis and bacterial activity of serum are depressed in patients with diabetes. In this study we proposed to determine whether the clinical or radiological findings, the causative organisms or the out-come of pneumonia are modified by presence of diabetes mellitus as underlying disease. Material and Methods: This is a Prospective study conducted among 30 diabetic patients and 30 non-diabetic patients with bacterial pneumonia admitted at Prathima Institute of Medical Sciences. A diagnosis of diabetes mellitus was based on previous clinical and /or biochemical diagnosis and /or treatment with oral anti-diabetic agents or insulin. Sputum was collected for bacteriological examination after rinsing the mouth with saline before institution of antibiotic therapy and subjected to following tests. Sputum was examined macroscopically with respect to quantity, colour, odour and evidence of haemoptysis. All the sputum smears were stained with gram’s stain.Those smears which showed more than 25 polymorphs per low power field and less than 10 squamous epithelial cells per low power field was considered as appropriate sample and others as inappropriate. Sputum was also examined for AFB by Ziehl nelson (ZN) stain. The purulent portion of the sputum was inoculated on blood agar, Mac conkey’s medium and heat blood agar. These were read after overnight incubation. Results: The average age in SG was 46.43 ± 8.65 yrs and in CG were 44.3 ± 9.37 yrs. Most of the patients (80% in SG and 70% in CG) were between 40 to 60 years. Most of the patients in both groups were males (66.7% in CG and 80% in SG). There was no statistically significant difference regarding sex in both the groups. The commonly associated co morbidities in CG and SG were Asthma (3.3% vs 6.7%), COPD (16.7% vs 23.3%) and IHD (10% vs 20%). There was no statistically significance difference of associated co morbidities in between two groups (p = 0.207). The complications in diabetic group were Pleural effusion (13.3%), septic shock (16.7%), Renal failure (3.3%) & MODS (3.3%) in comparison with Non – Diabetic group were Pleural effusion (6.7%), septic shock (10%). Patients in diabetic group were predominantly among PSI class IV and V (53.3%), in comparison with non – diabetic group who were predominantly in PSI Class I (53.3%). Conclusion: In patients with pneumonia, Diabetes mellitus is a significant prognostic factor of mortality. Polymicrobial etiology, multilobe involvement and increased severity in the form of high PSI score are associated with poor prognosis. Comorbidities of the patients rather than microbiological findings attribute to adverse outcome. Associated comorbidities like CVA, IHD, COPD and asthma had poor outcome in both the groups. However, diabetics had worse outcome compared to non-diabetics. Thus emphasizing on the fact that more efforts are needed to increase awareness of impact of uncontrolled DM on the clinical outcome of CAP.