Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study

Belén Millet Pascual-Leone¹, Facundo Fiocca Vernengo¹, David Hillus¹, Charlotte Wernicke², Gopinath Krishnamoorthy^{1

3}, Jan Rupp^{3

4}, Gernot Rohde^{3

5

6}, Mathias W Pletz^{3

7}, Martin Witzenrath^{1

3

8}; CAPNETZ-study group; Norbert Suttorp^{1

3}, Leif Erik Sander¹, Andreas Vestergaard Jensen⁹, Bastian Opitz^{1

8}, Charlotte Thibeault^{10

11}

Collaborators, Affiliations

Collaborators

CAPNETZ-study group:
A Fuchs, G Paul, M Ayoub, A Prasse, W Bauer, E C Diehl-Wiesenecker, N Galtung, C Kodde, Y-M Stoppe, C Boesecke, S Breitschwerdt, D Benke, S Schmager, A Grünewaldt, J Wheeler, B Schaaf, J Kremling, M Kolditz, B Schulte-Hubbert, J Ronczka, A Seeger, J Kohlhäufl, D Stolz, S Fähndrich, M Panning, M Unnewehr, R Lim, M Hoeper, I Pink, N Drick, T Fühner, T Steinberg, G Barten-Neiner, W Kröner, O Unruh, N Adaskina, F Eberhardt, T Illig, N Klopp, B T Schleenvoigt, A Moeser, D Drömann, P Parschke, K Franzen, F Waldeck, B Gebel, N Käding, S Boutin, J Schneider, J Erber, F Voit, D Heigener, I Hering, W Albrich, F Rassouli, B Wirth, C Neurohr, A Essig, S Stenger, M Wallner, H Burgmann, L Traby, L Schubert

Affiliations

¹ Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
² Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ CAPNETZ Stiftung, Hannover, Germany.
⁴ Infectious Diseases Clinic and Institute of Medical Microbiology, University Hospital Schleswig-Holstein, Luebeck, Germany.
⁵ Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany.
⁶ Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
⁷ Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
⁸ German Center for Lung Research (DZL), Berlin, Germany.
⁹ Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
¹⁰ Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. charlotte.thibeault@charite.de.
¹¹ Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany. charlotte.thibeault@charite.de.

PMID: 41077620
DOI: 10.1007/s15010-025-02659-w

Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study

Belén Millet Pascual-Leone et al. Infection. 2025.

. 2025 Oct 12.

doi: 10.1007/s15010-025-02659-w. Online ahead of print.

Authors

Collaborators

CAPNETZ-study group:
A Fuchs, G Paul, M Ayoub, A Prasse, W Bauer, E C Diehl-Wiesenecker, N Galtung, C Kodde, Y-M Stoppe, C Boesecke, S Breitschwerdt, D Benke, S Schmager, A Grünewaldt, J Wheeler, B Schaaf, J Kremling, M Kolditz, B Schulte-Hubbert, J Ronczka, A Seeger, J Kohlhäufl, D Stolz, S Fähndrich, M Panning, M Unnewehr, R Lim, M Hoeper, I Pink, N Drick, T Fühner, T Steinberg, G Barten-Neiner, W Kröner, O Unruh, N Adaskina, F Eberhardt, T Illig, N Klopp, B T Schleenvoigt, A Moeser, D Drömann, P Parschke, K Franzen, F Waldeck, B Gebel, N Käding, S Boutin, J Schneider, J Erber, F Voit, D Heigener, I Hering, W Albrich, F Rassouli, B Wirth, C Neurohr, A Essig, S Stenger, M Wallner, H Burgmann, L Traby, L Schubert

Affiliations

¹ Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
² Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
³ CAPNETZ Stiftung, Hannover, Germany.
⁴ Infectious Diseases Clinic and Institute of Medical Microbiology, University Hospital Schleswig-Holstein, Luebeck, Germany.
⁵ Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany.
⁶ Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.
⁷ Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
⁸ German Center for Lung Research (DZL), Berlin, Germany.
⁹ Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
¹⁰ Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. charlotte.thibeault@charite.de.
¹¹ Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany. charlotte.thibeault@charite.de.

PMID: 41077620
DOI: 10.1007/s15010-025-02659-w

Abstract

Purpose: Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM-) patients in a European CAP cohort.

Methods: Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002-2022, with and without a history of DM, were conducted.

Results: Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM- patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31-202) vs. 86 mg/L (IQR: 24-190), p < 0.0001; median leucocyte count 12/nl (IQR: 9-16)vs. 11/nl (IQR: 8-15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM- patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), p_adj < 0.01).

Conclusions: CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.

Keywords: Community-acquired pneumonia; Diabetes mellitus; Enterobacteriaceae; Pathogen spectrum.

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Conflict of interest statement

Declarations. Competing interests: G.R. received personal fees from Astra Zeneca, Atriva, Boehringer Ingelheim, GSK, Insmed, MSD, Sanofi, Novartis and Pfizer for consultancy during advisory board meetings and personal fees from Astra Zeneca, Berlin Chemie, BMS, Boehringer Ingelheim, Chiesi, Essex Pharma, Grifols, GSK, Insmed, MSD, Roche, Sanofi, Solvay, Takeda, Novartis, Pfizer and Vertex for lectures. M.P. received consulting fees and/or payment for honoraria for lectures and presentations from Pfizer, MSA, Sanofi, Janssen, GSK, Astrazeneca, Shionogi and Infectiopharm, Biomerieux and Sanofi, support for attending meetings and/or travel from Pfizer, MSD, has a patent planned with bioactive glass element, participated in data safety monitoring board or advisory board of Biomerieux and Sanofi and is president of the Paul Ehrlich Society for Antiinfective Chemotherapy and Board of Director of CAPNETZ and German Sepsis Society. M.W. received funding from the German Research Foundation—SFB 1449 (project ID 431232613), sub-project B02, from the German Federal Ministry of Research, Technology and Space in the framework of e:Med SYMPATH (01ZX2206A, 01ZX1906A), NUM-NAPKON (01KX2121, 01KX2021), CAP-TSD (031L0286B), PROGRESS (82DZLJ19C1, 82DZLJ19B1), NAPCODE (01EQ2406B), from the Federal Joint Committee (G-BA)—T-CABS (01NVF23109), from the Federal Ministry of Health (BMG)—PAIS Care (ZMII2-2524FSB105), from the Ministry of Defence—NoVAP (E/U2ED/PD014/OF550), and from Aptarion, Pantherna and Biotest for research outside the current study, and for lectures and advisory from Astra Zeneca, Chiesi, Insmed, Gilead, Pfizer, Boehringer, Biotest, Pantherna and Aptarion.

References

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Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study

Collaborators

Affiliations

Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources

Research Materials

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