Increased Antimicrobial Resistance among Sputum Pathogens from Patients with Hyperglycemia

Figures & data

Table 1 Demographics of Patients among the three groups

	Normal	Hyperglycemia on Admission	p-value^a	Diabetes	p-value^b	p-value^c
n	582	292		289
Female (%)	178 (30.6)	83 (28.4)	0.511	100 (34.6)	0.131	0.231
Age (years)	66 (54.5–77.0)	65 (55.0–76.0)	ns	68(60.0–78.0)	<0.05	<0.05
BMI (kg/m^2)	22.0 (19.4–24.2)	23.1 (20.2–25.7)	<0.05	24.0(21.2–26.8)	<0.05	<0.05
Smokers, n (%)	192 (33.0)	93 (31.9)	0.611	92 (31.8)	0.621	0.771
Comorbidity, n (%)
Lung diseases	113 (19.4)	50 (17.1)	0.412	66 (22.8)	0.121	0.239
Cardiovascular diseases	110 (18.9)	57 (19.5)	0.010	104 (36.0)	<0.001	<0.001
Hypertension	197 (33.9)	117 (40.1)	0.071	169 (58.5)	<0.001	<0.001
Malignant tumors	190 (32.7)	86 (29.5)	0.338	69 (23.9)	0.013	0.008
Immunocompromised, n (%)	49 (8.4)	15 (5.1)	0.207	18 (6.2)	0.374	0.273
Hospitalization within 3m, n (%)	137 (23.5)	66 (22.6)	0.915	69 (23.9)	0.903	0.959
Hospitalization within 1m, n (%)	175 (30.6)	99 (33.9)	0.514	92 (31.8)	0.825	0.734
Glucocorticoid use, n (%)	42 (7.3)	15 (5.1)	0.501	30 (10.4)	0.336	0.164
Mechanical ventilation, n (%)	29 (5.1)	36 (12.3)	<0.001	16 (5.5)	0.271	0.728
Central venous catheter, n (%)	68 (11.9)	65 (22.3)	<0.001	23 (8.0)	0.002	0.091
ICU admission, n (%)	61 (10.7)	45 (15.4)	0.035	51 (17.7)	0.017	0.003
Survival rate, n (%)	478 (83.6)	209 (71.6)	<0.001	220 (76.1)	0.378	0.036

Notes: ^a–cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.

Table 2 Isolate Distribution Among the Three Groups

	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c
	Normal (%)	Hyperglycemia on Admission (%)
All			0.005		0.057	0.378
Enterobacteriaceae	265 (33.3)	125 (29.3)		154 (39.3)
A. baumannii	133 (16.7)	92 (21.6)		59 (15.1)
S. aureus	169 (21.2)	109 (25.5)		70 (17.9)
P. aeruginosa	88 (11.0)	32 (7.5)		37 (9.4)
S. maltophilia	58 (7.3)	40 (9.4)		30 (7.7)
Other	84 (10.5)	29 (6.8)		42 (10.7)
Enterobacteriaceae			0.506		0.955	0.863
K. pneumoniae	185 (69.8)	92 (73.6)		110 (71.4)
Non–K. pneumoniae	80 (30.2)	33 (26.4)		44 (28.6)
Isolates, n^a			<0.001		0.046	<0.001
Monomicrobial	244 (44.5)	73 (25.4)		104 (31.7)
Polymicrobial	304 (55.5)	214 (74.6)		224 (68.3)
MDR of GNB
K. pneumoniae	61 (35.1)	54 (62.1)	<0.001	44 (42.3)	0.760	0.228
A. baumannii	71 (55.9)	61 (68.5)	0.061	29 (53.7)	0.321	0.785
P. aeruginosa	52 (61.9)	17 (54.8)	0.493	24 (68.6)	0.360	0.490
S. aureus			0.010		0.315	0.073
MSSA	66 (41.5)	28 (26.2)		19 (28.8)
MRSA	93 (58.5)	79 (73.8)		47 (71.2)

Notes: ^a–cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.

Table 3 Antibiotic-Resistance Rate of K. pneumoniae Isolated from Sputum

	n	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c
		Normal (%)	Hyperglycemia on Admission (%)
ESBL	346	27 (16.3)	13 (15.9)	0.996	21 (21.5)	0.505	0.574
Penicillin
Ampicillin	341	151 (93.2)	77 (96.3)	0.602	94 (950)	0.428	0.680
β-lactam/β-lactamase inhibitor Combinations
Ampicillin–sulbactam	359	46 (26.9)	47 (54.7)	<0.001	30 (29.4)	0.406	0.859
Piperacillin–tazobactam	356	25 (14.7)	29 (34.5)	0.001	15 (14.7)	0.358	0.986
Cefoperazone–sulbactam	335	22 (13.8)	30 (39.0)	<0.001	13 (13.3)	0.176	0.986
Cephems
Ceftriaxone	325	54 (35.3)	45 (57.7)	<0.001	39 (41.5)	0.637	0.329
Ceftazidime	363	41 (23.7)	39 (45.4)	<0.001	29 (27.8)	0.836	0.682
Cefepime	363	27 (15.7)	34 (39.1)	<0.001	23 (22.1)	0.437	0.281
Monobactams
Aztreonam	322	46 (30.3)	39 (50.7)	0.003	31 (33.3)	0.074	0.159
Quinolones
Ciprofloxacin	363	42 (24.4)	38 (43.7)	0.007	30 (28.9)	0.671	0.561
Levofloxacin	322	36 (24.0)	32 (41.0)	0.028	21 (22.3)	0.196	0.578
Aminoglycosides
Gentamycin	363	37 (21.4)	40 (46.0)	<0.001	21 (20.4)	0.074	0.844
Amikacin	363	22 (12.7)	29 (33.3)	<0.001	15 (14.6)	0.428	0.680
Folate-pathway inhibitors
Trimethoprim–sulfamethoxazole	364	31 (17.9)	35 (40.2)	<0.001	21 (20.2)	0.173	0.382
Carbapenems
Ertapenem	323	33 (21.9)	28 (35.9)	0.069	23 (24.5)	0.599	0.662
Imipenem	364	30 (17.3)	31 (35.6)	0.002	16 (15.4)	0.193	0.914
Meropenem	333	26 (16.6)	28 (35.9)	0.003	15 (15.3)	0.245	0.915
Glycylcycline
Tigecycline	296	2 (1.4)	4 (5.8)	0.140	2 (2.3)	0.830	0.628
Other
Fosfomycin	283	34 (26.4)	24 (35.3)	0.221	23 (26.7)	0.880	0.861

Notes: ^a–cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.

Table 4 Antibiotic-Resistance Rate of A. baumannii Isolated from Sputum

	n	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c
		Normal (%)	Hyperglycemia on Admission (%)
β-lactam–β-lactamase inhibitor combinations
Ampicillin–sulbactam	264	56 (45.2)	44 (50.6)	0.180	13 (24.5)	0.010	0.020
Piperacillin–tazobactam	182	38 (42.2)	27 (49.1)	0.655	15 (40.5)	0.227	0.331
Cefoperazone–sulbactam	242	32 (28.1)	21 (27.6)	0.166	8 (15.5)	0.178	0.181
Cephems
Ceftriaxone	227	57 (53.8)	47 (60.3)	0.642	18 (41.9)	0.217	0.399
Ceftazidime	268	66 (52.4)	54 (60.8)	0.446	25 (47.2)	0.478	0.702
Cefepime	265	64 (50.8)	53 (60.9)	0.344	26 (50.0)	0.815	0.995
Quinolones
Ciprofloxacin	269	72 (56.7)	55 (62.5)	0.403	29 (53.7)	0.167	0.136
Levofloxacin	229	36 (33.3)	25 (32.1)	0.863	13 (30. 2)	0.818	0.885
Aminoglycosides
Amikacin	247	22 (19.1)	24 (30.0)	0.200	11 (21.2)	0.820	0.799
Gentamycin	270	57 (44.9)	48 (53.9)	0.239	25 (46.3)	0.820	0.640
Folate-pathway inhibitors
Trimethoprim–sulfamethoxazole	268	59 (46.8)	48 (54.6)	0.221	26 (48.2)	0.644	0.520
Carbapenems
Imipenem	268	63 (50.0)	55 (62.5)	0.194	24 (44.4)	0.123	0.281
Meropenem	243	56 (49.6)	49 (62.8)	0.158	23 (44.2)	0.338	0.648
Glycylcycline
Tigecycline	199	12 (12.8)	7 (11.1)	0.949	6 (14.3)	0.366	0.428

Notes: ^a–cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.

Table 5 Antibiotic-Resistance Rate of P. aeruginosa Isolated from Sputum

	n	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c
		Normal (%)	Hyperglycemia on Admission (%)
β-lactam–β-lactamase inhibitor combinations
Piperacillin–tazobactam	141	8 (10.1)	2 (6. 7)	0.460	3 (9.4)	0.61	0.791
Cefoperazone–sulbactam	137	8 (10.7)	6 (20.7)	0.405	3 (9.1)	0.796	0.964
Cephems
Ceftazidime	148	10 (12.2)	7 (22.6)	0.346	4 (11.4)	0.866	0.978
Cefepime	143	12 (14.8)	5 (17.9)	0.649	4 (11.8)	0.528	0.470
Monobactam
Aztreonam	130	14 (19.4)	6 (21.4)	0.881	3 (10.0)	0.435	0.502
Quinolones
Ciprofloxacin	150	18 (21.4)	8 (25.8)	0.770	6 (17.1)	0.271	0.266
Levofloxacin	119	7 (10.6)	6 (25.0)	0.217	5 (17.2)	0.694	0.532
Aminoglycosides
Amikacin	144	6 (7.3)	3 (9. 7)	0.526	3 (9.7)	0.952	0.889
Gentamycin	147	8 (9.6)	1 (3.3)	0.448	3 (8.8)	0.280	0.334
Carbapenems
Imipenem	149	24 (28. 9)	10 (32.3)	0.764	12 (34.3)	0.341	0.451
Meropenem	141	25 (32.1)	8 (25.8)	0.255	8 (25.0)	0.810	0.532
Other
Fosfomycin	108	22 (37.9)	6 (25.0)	0.454	8 (30.8)	0.723	0.720

Notes: ^a_cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.

Table 6 Antibiotic-Resistance rate of S. aureus Isolated from Sputum

	MSSA							MRSA
	n	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c	No	Without Diabetes		p-value^a	Diabetes (%)	p-value^b	p-value^c
		Normal (%)	Hyperglycemia on Admission (%)						Normal (%)	Hyperglycemia on Admission (%)
Penicillin G	112	51 (78.5)	21 (75.0)		17 (89.5)			219	93 (100)	79 (100)	—	47 (100)	—	—
Oxacillin	0	0	0	—	0	—	—	219	93 (100)	79 (100)	—	47 (100)	—	…
Erythromycin	112	27 (41.5)	9 (32.1)	0.647	5 (26.3)	0.059	0.483	217	80 (87.9)	71 (89.9)	0.686	44 (93.6)	0.335	0.293
Clindamycin	111	16 (24.6)	5 (18.5)	0.274	3 (15.8)	0.256	0.104	215	72 (80.0)	61 (78.2)	0.881	41 (87.2)	0.323	0.355
Gentamicin	112	4 (6.2)	2 (7.1)	0.859	2 (10.5)	0.530	0.515	218	58 (63.0)	50 (63.3)	0.902	33 (70.2)	0.493	0.472
Levofloxacin	110	2 (3.1)	4 (15.4)	0.076	6 (31.6)	0.006	<0.001	212	76 (83.5)	55 (74.3)	0.151	37 (78.7)	0.896	0.341
Ciprofloxacin	57	2 (5.1)	2 (22.2)	0.227	3 (33.3)	0.105	0.042	111	34 (72.3)	26 (70.3)	0.627	21 (77.8)	0.725	0.698
Sulfamethoxazole–trimethoprim	113	3 (4.6)	2 (7.1)	0.608	0	0.304	0.344	216	4 (4.4)	5 (6.4)	0.550	5 (10.6)	0.187	0.154
Rifampin	113	1 (1.5)	0	0.648	0	0.814	0.745	217	11(12.1)	7 (8.9)	0.786	4 (8.5)	0.378	0.353
Vancomycin	0	0	0	—	0	—	—	0	0	0	—	0	—	—
Linezolid	0	0	0	—	0	—	—	0	0	0	—	0	—	—
Teicoplanin	0	0	0	—	0	—	—	0	0	0	—	0	—	—

Notes: ^a–cNormal vs hyperglycemia on admission, with diabetes vs without diabetes, and normal vs diabetes, respectively.