Advertisement

Bacteriological profile of sepsis and its correlation with procalcitonin in patients with diabetes mellitus

  • Ashwani KumarEmail author
  • Pawan Sagar
  • Bineeta Kashyap
  • S.V. Madhu
  • Aditi
  • Nishesh Jain
Original Article
  • 20 Downloads

Abstract

Bloodstream infections can lead to life-threatening sepsis and require rapid antimicrobial treatment. It is an accepted opinion that diabetes worsens prognosis of infection, particularly sepsis, although there is not much data published on this subject. The aim was to study the bacteriological profile of sepsis in patients of diabetes mellitus (DM) and the correlation of procalcitonin as biomarker of sepsis and blood culture positivity. Study was conducted at University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital from December 2013 to November 2014. Thirty known diabetic patients with signs and symptoms of sepsis were enrolled for the study irrespective of age, sex, and type of diabetes. Blood samples were taken for blood culture, estimation of procalcitonin and blood glucose levels, fasting and postprandial and glycosylated hemoglobin, and other relevant biochemical tests. Out of the 30 samples, 9 (30%) patients yielded growth; among them, 66.6% were found to be Staphylococcus aureus and 33.3% were Klebsiella pneumoniae. Median procalcitonin (PCT) levels in positive blood culture subjects were significantly higher than those with negative blood culture. We observed blood culture positivity in 30% of the patients of DM with sepsis, predominance of Gram-positive bacteria, and significantly higher PCT levels in blood culture-positive patients.

Keywords

Diabetes mellitus Sepsis Bacteriological profile Procalcitonin 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Knapp S. Diabetes and infection: is there a link?—a mini review. Gerontology. 2013;59(2):99–104.CrossRefGoogle Scholar
  2. 2.
    Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41:281–8.CrossRefGoogle Scholar
  3. 3.
    Koh GC, Peacock SJ, van der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis. 2012;31(4):379–88.CrossRefGoogle Scholar
  4. 4.
    Kawahito S, Kitahata H, Oshita S. Problem associated with glucose toxicity: role of hyperglycemia-induced oxidative stress. World J Gastroentrol. 2009;15(33):4137–5142.CrossRefGoogle Scholar
  5. 5.
    Weinstein MP. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24:584–602.CrossRefGoogle Scholar
  6. 6.
    Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001;164:396–402.CrossRefGoogle Scholar
  7. 7.
    Jin M, Khan AI. Procalcitonin: uses in the clinical laboratory for the diagnosis of sepsis. Lab Med. 2010;41(3):173–7.CrossRefGoogle Scholar
  8. 8.
    Collee JG, Miles RS, Watt B. Tests for identification of bacteria. Mackie & McCartney practical medical microbiology. 14th ed. New York & London: Churchill Livingstone; 1996. p. 131–49.Google Scholar
  9. 9.
    CLSI. Performance standards for antimicrobial susceptibility testing. 19th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.Google Scholar
  10. 10.
    Rawat V, Singhai M, Kumar A, Jha PK, Goyal R. Bacterial and resistance profile in isolates from diabetic patients. Am J Med Sci. 2012;4(11):563–8.CrossRefGoogle Scholar
  11. 11.
    Jain SK, Barman R. Bacteriological profile of diabetic foot ulcer with special reference to drug-resistant strains in a tertiary care center in North-East India. Indian J Endocrinol Metab. 2017;21(5):688–94.CrossRefGoogle Scholar
  12. 12.
    Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complicat. 2005;19:138–41.CrossRefGoogle Scholar
  13. 13.
    Amini M, Davati A, Piri M. Determination of the resistance pattern of prevalent aerobic bacterial infections of diabetic foot ulcer. Iran J Pathol. 2013;8:21–6.Google Scholar
  14. 14.
    Michalia M, Kompoti M, Koutsikou A, Paridou A, Giannopoulou P, Trikka-Graphakos E, et al. Diabetes mellitus is an independent risk factor for ICU-acquired bloodstream infections. Intensive Care Med. 2009;35(3):448–54.CrossRefGoogle Scholar
  15. 15.
    Asati DP, Sharma VK, Khandpur S, Khilnani GC, Kapil A. Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi. Indian J Dermatol Venereol Leprol. 2011;77:141–7.CrossRefGoogle Scholar
  16. 16.
    van Nieuwkoop C, Bonten TN, van’tWout JW, Kuijper EJ, Groeneveld GH, Becker MJ, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care. 2010;14(6):R206.CrossRefGoogle Scholar
  17. 17.
    Chirouze C, Schuhmacher H, Rabaud C, Gil H, Khayat N, Estavoyer JM, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis. 2002;35:156–61.CrossRefGoogle Scholar
  18. 18.
    Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Med [Internet]. 2017;15(1):15.CrossRefGoogle Scholar
  19. 19.
    Yu Y, Li XX, Jiang LX, Du M, Liu ZG, Cen ZR, et al. Procalcitonin levels in patients with positive blood culture, positive body fluid culture, sepsis, and severe sepsis: a cross-sectional study. Infect Dis (Lond). 2016;48(1):63–9.CrossRefGoogle Scholar
  20. 20.
    Guo SY, Zhou Y, Hu QF, Yao J, Wang H. Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis. Am J Med Sci. 2015;349(6):499–504.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  • Ashwani Kumar
    • 1
    Email author
  • Pawan Sagar
    • 1
  • Bineeta Kashyap
    • 1
  • S.V. Madhu
    • 2
  • Aditi
    • 1
  • Nishesh Jain
    • 3
  1. 1.Department of MicrobiologyUniversity College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBHDelhiIndia
  2. 2.Department of EndocrinologyUCMS & GTB HospitalDelhiIndia
  3. 3.Department of MedicineUniversity of AlabamaTuscaloosaUSA

Personalised recommendations