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.

Original language	English
Journal	Infection
Volume	54
Issue number	1
Pages (from-to)	275-285
Number of pages	11
ISSN	0300-8126
DOIs	https://doi.org/10.1007/s15010-025-02659-w
Publication status	Published - 02.2026

Funding

Funders	Funder number
Chiesi Farmaceutici S.p.A.
Boehringer-Ingelheim
Aptarion, Pantherna and Biotest
Astra Zeneca R and D
Pfizer
Berlin Institute of Health (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

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Academic Focus: Center for Infection and Inflammation Research (ZIEL)

DFG Research Classification Scheme

2.21-03 Medical Microbiology and Mycology, Hygiene, Molecular Infection Biology
2.22-17 Endocrinology, Diabetology, Metabolism
2.22-13 Pneumology, Thoracic Surgery
2.21-05 Immunology

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10.1007/s15010-025-02659-w

Cite this

@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",

}

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 -

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

Funding

UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

Access to Document

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