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

the CAPNETZ Study Group

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

the CAPNETZ Study Group

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.

Originalsprache	Englisch
Zeitschrift	Infection
Jahrgang	54
Ausgabenummer	1
Seiten (von - bis)	275-285
Seitenumfang	11
ISSN	0300-8126
DOIs	https://doi.org/10.1007/s15010-025-02659-w
Publikationsstatus	Veröffentlicht - 02.2026

Fördermittel

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. Open Access funding enabled and organized by Projekt DEAL. Open Access funding enabled and organized by Projekt DEAL. CAPNETZ was funded by a grant from the German Federal Ministry of Education and Research (FKZ 01KI07145) 2001–2011 and has been an associated member of the German Center for Lung Research (FKZ 82DZL002B4) since 2013. M.P. was funded by a grant from the German Federal Ministry for Education and Research. C.T. is participant in the BIH Charité Clinician Scientist Program funded by the Charité—Universitätsmedizin Berlin and the Berlin Institute of Health at Charité (BIH).

Träger	Trägernummer
Chiesi Farmaceutici S.p.A.
Boehringer Ingelheim
Aptarion, Pantherna and Biotest
Astra Zeneca R and D
Pfizer
Berliner Institut für Gesundheitsforschung (BIH)
Ministry of Defence	E/U2ED/PD014/OF550
German Research Foundation	431232613, SFB 1449
CAP-TSD	031L0286B
Center for American Progress	01EQ2406B, 82DZLJ19B1, 82DZLJ19C1
Federal Joint Committee Innovation Fund	01NVF23109
Bundesministerium für Forschung, Technologie und Raumfahrt	FKZ 01KI07145, FKZ 82DZL002B4
Bundesministerium für Gesundheit (BMG)	ZMII2-2524FSB105
German Federal Ministry of Research, Technology and Space	01ZX1906A, 01ZX2206A
NUM-NAPKON	01KX2121, 01KX2021

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

Strategische Forschungsbereiche und Zentren

Forschungsschwerpunkt: Infektion und Entzündung - Zentrum für Infektions- und Entzündungsforschung Lübeck (ZIEL)

DFG-Fachsystematik

2.21-03 Medizinische Mikrobiologie und Mykologie, Hygiene, Molekulare Infektionsbiologie
2.22-17 Endokrinologie, Diabetologie, Metabolismus
2.22-13 Pneumologie, Thoraxchirurgie
2.21-05 Immunologie

Dokumente

10.1007/s15010-025-02659-w

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@article{71c30b014e7d40ebb1121365208f1f9e,

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

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), padj < 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.",

author = "\{the CAPNETZ Study Group\} and \{Millet Pascual-Leone\}, Bel{\'e}n and \{Fiocca Vernengo\}, Facundo and David Hillus and Charlotte Wernicke and Gopinath Krishnamoorthy and Jan Rupp and Gernot Rohde and Pletz, \{Mathias W.\} and Martin Witzenrath and L. Schubert and L. Traby and H. Burgmann and M. Wallner and S. Stenger and A. Essig and C. Neurohr and B. Wirth and F. Rassouli and W. Albrich and I. Hering and D. Heigener and F. Voit and J. Erber and J. Schneider and S. Boutin and N. K{\"a}ding and B. Gebel and F. Waldeck and K. Franzen and P. Parschke and D. Dr{\"o}mann and A. Moeser and Schleenvoigt, \{B. T.\} and N. Klopp and T. Illig and F. Eberhardt and N. Adaskina and O. Unruh and W. Kr{\"o}ner and G. Barten-Neiner and T. Steinberg and T. F{\"u}hner and N. Drick and I. Pink and M. Hoeper and R. Lim and M. Unnewehr and D. Stolz and B. Schaaf and A. Fuchs",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2026",

month = feb,

doi = "10.1007/s15010-025-02659-w",

language = "English",

volume = "54",

pages = "275--285",

journal = "Infection",

issn = "0300-8126",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "1",

}

Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study. / the CAPNETZ Study Group.
in: Infection, Jahrgang 54, Nr. 1, 02.2026, S. 275-285.

Publikation: Beiträge in Fachzeitschriften › Zeitschriftenaufsätze › Forschung › Begutachtung

TY - JOUR

T1 - Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation

T2 - results from CAPNETZ, a prospective observational cohort study

AU - the CAPNETZ Study Group

AU - Millet Pascual-Leone, Belén

AU - Fiocca Vernengo, Facundo

AU - Hillus, David

AU - Wernicke, Charlotte

AU - Krishnamoorthy, Gopinath

AU - Rupp, Jan

AU - Rohde, Gernot

AU - Pletz, Mathias W.

AU - Witzenrath, Martin

AU - Schubert, L.

AU - Traby, L.

AU - Burgmann, H.

AU - Wallner, M.

AU - Stenger, S.

AU - Essig, A.

AU - Neurohr, C.

AU - Wirth, B.

AU - Rassouli, F.

AU - Albrich, W.

AU - Hering, I.

AU - Heigener, D.

AU - Voit, F.

AU - Erber, J.

AU - Schneider, J.

AU - Boutin, S.

AU - Käding, N.

AU - Gebel, B.

AU - Waldeck, F.

AU - Franzen, K.

AU - Parschke, P.

AU - Drömann, D.

AU - Moeser, A.

AU - Schleenvoigt, B. T.

AU - Klopp, N.

AU - Illig, T.

AU - Eberhardt, F.

AU - Adaskina, N.

AU - Unruh, O.

AU - Kröner, W.

AU - Barten-Neiner, G.

AU - Steinberg, T.

AU - Fühner, T.

AU - Drick, N.

AU - Pink, I.

AU - Hoeper, M.

AU - Lim, R.

AU - Unnewehr, M.

AU - Stolz, D.

AU - Schaaf, B.

AU - Fuchs, A.

PY - 2026/2

Y1 - 2026/2

N2 - 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), padj < 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.

AB - 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), padj < 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.

UR - https://www.scopus.com/pages/publications/105018612647

UR - https://www.mendeley.com/catalogue/510331dc-50dc-37bf-8206-4466b0d3a113/

U2 - 10.1007/s15010-025-02659-w

DO - 10.1007/s15010-025-02659-w

M3 - Journal articles

C2 - 41077620

AN - SCOPUS:105018612647

SN - 0300-8126

VL - 54

SP - 275

EP - 285

JO - Infection

JF - Infection

IS - 1

ER -