%0 Journal Article
%T Diabetes and Hemoglobin A1c as Risk Factors for Nosocomial Infections in Critically Ill Patients
%A Eirini Tsakiridou
%A Demosthenes Makris
%A Vasiliki Chatzipantazi
%A Odysseas Vlachos
%A Grigorios Xidopoulos
%A Olympia Charalampidou
%A Georgios Moraitis
%A Epameinondas Zakynthinos
%J Critical Care Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/279479
%X Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients. Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. Inclusion criteria: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU. Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91每20.17; ) and blood transfusion 3.33 (1.23每9.02; ) were independent risk factors for VAP. BSI in ICU ( ) and ICU mortality ( ) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14每5.29; ) and stroke on admission2.77 (1.12每6.88; ). Sepsis 3.34 (1.47每7.58; ) and parenteral feeding 6.29 (1.59每24.83; ) were independently associated with ICU mortality. HbA1c ≡ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU. Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU. 1. Introduction Ventilator-associated pneumonia (VAP) often complicates the clinical course of the critically ill patients and it may be associated with considerable morbidity and mortality [1]. VAP can be precipitated by several factors which may be associated with the underlying disease, the critical interventions that are performed in the intensive care unit (ICU), or the logical impairment that has been described in the critical illness [2, 3]. Hyperglycemia and diabetes mellitus (DM) are conditions which have been linked to alterations of immune response and are often encountered in the critical care setting [4]. However, acute hyperglycemia is usually treated in ICU and the level of alertness of physicians for the possible complications of acute hyperglycemia and DM in critically ill patients is high [5]. On the other hand, it is not known whether diabetic patients with a history of less optimum diabetic control, such as those with abnormal hemoglobin A1c (HbA1c), could be at a higher risk of ICU infections compared to diabetics with a history of well-controlled DM prior to ICU admission. Previous studies have examined the correlation between HbA1c and the outcome in diabetic patients with sepsis but the
%U http://www.hindawi.com/journals/ccrp/2013/279479/