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 (1.91–20.17;P=0.002) and blood transfusion 3.33 (1.23–9.02;P=0.018) were independent risk factors for VAP. BSI in ICU (P=0.044) and ICU mortality (P=0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14–5.29;P=0.022) and stroke on admission2.77 (1.12–6.88;P=0.029). Sepsis 3.34 (1.47–7.58;P=0.004) and parenteral feeding 6.29 (1.59–24.83;P=0.009) 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.
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机译：目的。评估危重患者的糖尿病（DM）和血红蛋白A1c（HbA1c）是否是呼吸机相关性肺炎（VAP）和血流感染（BSI）的危险因素。前瞻性观察研究;该患者于2010年至2012年之间从一家地区医院的重症监护病房（ICU）招募。纳入标准：ICU住院时间> 72小时，机械通气时间> 48小时。计算所有参与者的HbA1c。 DM，HbA1c以及其他临床和实验室参数被评估为ICU中VAP或BSI的危险因素。 VAP和BSI的总体ICU发生率分别为26％和30％。肠内喂养OR（95％CI）6.20（1.91–20.17; P = 0.002）和输血3.33（1.23–9.02; P = 0.018）是VAP的独立危险因素。糖尿病患者的ICU BSI（P = 0.044）和ICU死亡率（P = 0.038）显着增加。 ICU BSI的独立危险因素包括入院时BSI 2.45（1.14-5.29; P = 0.022）和入院时卒中2.77（1.12-6.88; P = 0.029）。脓毒症3.34（1.47–7.58; P = 0.004）和肠胃外喂养6.29（1.59–24.83; P = 0.009）与ICU死亡率独立相关。 HbA1c≥8.1％在诊断ICU中反复的BSI中表现出显着的诊断性能。结论。 DM和HbA1c与增加的VAP或BSI频率无关。 HbA1c与ICU中反复的BSI发作相关。
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