Management of community-acquired pneumonia in adults with type 2 diabetes mellitus in a multidisciplinary hospital

Abstract

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest.Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines.Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM.Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients.Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.