今回の文献の目的は
菌血症で入院した糖尿病患者の
細菌、菌血症の原因、合併症および治療結果を
非糖尿病の菌血症患者と比較することです。
糖尿病患者119名と非糖尿病者480名に対し
菌血症で入院時の静脈中の細菌と
死亡率と入院期間について調べています。
To compare the microbiology, sources, complications, and outcome of bacteremia in diabetic and nondiabetic patients.
A prospective study was conducted of all episodes of bacteremia in hospitalized diabetic and nondiabetic patients. The study consisted of patients greater than or equal to 18 yr of age with bacteremia detected within a 19-mo interval.
We compared 124 episodes of bacteremia in 119 diabetic patients to 508 episodes in 480 nondiabetic patients. Diabetic patients were older than nondiabetic patients (median age 74 vs. 68 yr, P = 0.0001). In patients with an indwelling urinary catheter and bacteremic urinary tract infection, the percentage of Klebsiella in diabetic patients was 60% (6 of 10) and in nondiabetic patients was 17% (4 of 23, P = 0.04). In patients without an obvious source of bacteremia, the percentage of staphylococcal isolates in diabetic patients was 29% (10 of 35) and in nondiabetic patients was 14% (24 of 176, P = 0.04). Staphylococci were a common cause of bacteremic infections of the extremities in diabetic patients (12 of 19, 63%) and nondiabetic patients (20 of 50, 40%). Septic shock was the only complication that was more common in diabetic patients. The mortality in diabetic and nondiabetic patients was 28 and 29%, respectively.
Our results represent elderly patients with non-insulin-dependent diabetes mellitus. In this group, empirical treatment for suspected bacteremic urinary tract infection in patients with a urinary catheter should include coverage for Klebsiella. Empiric treatment for suspected bacteremia of unknown origin or caused by infection of the extremities should include an antistaphylococcal drug. The prognosis of bacteremia in diabetic and nondiabetic patients was similar.
結果は、菌血症の原因として尿路感染が糖尿病患者で有意に多い。
死亡率と入院期間については両群間で有意差は無い。
結論は、菌血症で入院した糖尿病患者の治療結果は
非糖尿病者と変わらないということです。
.
引用文献
Leibovici L1, Samra Z, Konisberger H, Kalter-Leibovici O, Pitlik SD, Drucker M.
Bacteremia in adult diabetic patients.
Diabetes Care. 1991 Feb;14(2):89-94.