Study of Bacteriological and Clinical Profile of Community Acquired Pneumonia in Type 2 Diabetes Patients

Abstract

Introduction: Community-acquired pneumonia (CAP) remains a common and serious illness despite the availability of potent new anti-microbials and effective vaccines. Since pneumonia is not a reportable illness, information about its incidence is based on crude estimates. However, it appears that as many as four million cases of community-acquired pneumonia occur annually and as much as 20% of these require hospitalization. Pneumonia is increasingly common among older patients and those with co-morbidity like COPD, DM, renal failure, congestive heart failure, CLD and other conditions. Two major variables that influence the spectrum of etiologic agent and initial approach to therapy are the severity of initial presentation and presence of either co-existing illness or advanced age.
Material And Methods: This is a Prospective study of cases was conducted among 30 diabetic patients and 30 non-diabetic patients with bacterial pneumonia admitted in Tertiary Care Teaching Hospital. A detailed history was taken in all the patients with respect to presenting complaints (like fever, new or increasing sputum production, dyspnoea and Chest Pain) predisposing factors and accompanying illness. 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.
Results: The average age in non-diabetic patients was 47.3 ± 5.37 years and in Diabetic patients were 48.43 ± 5.65 years. 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). 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: The yield of causative organisms of Community Acquired pneumonia by routine sputum cultures is low. Among the organisms isolated gram-negative organisms predominated. Among the presenting symptoms breathlessness at presentation had significant association with mortality, whereas presence or absence of fever, cough or sputum production did not have any significant association with mortality.