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We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM\u2212) patients in a European CAP cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002\u20132022, with and without a history of DM, were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventeen percent (2310\/13,611) had a history of DM (DM+). Compared to DM\u2212 patients, DM+ patients had a higher 180\u00a0days mortality rate following CAP (13% (292\/2310) vs. 7% (766\/11,301),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and higher C-reactive protein and leucocyte counts (median CRP 97\u00a0mg\/L (IQR: 31\u2013202) vs. 86\u00a0mg\/L (IQR: 24\u2013190),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001; median leucocyte count 12\/nl (IQR: 9\u201316)vs. 11\/nl (IQR: 8\u201315),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Pathogens were identified in 23.4% (540\/2310) of the DM+ and 21.7% (2414\/11,301) of the DM\u2212 patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), 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),\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>adj<\/jats:sub>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02659-w","type":"journal-article","created":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T15:44:19Z","timestamp":1760283859000},"page":"275-285","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"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"],"prefix":"10.1007","volume":"54","author":[{"given":"Bel\u00e9n","family":"Millet Pascual-Leone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Facundo","family":"Fiocca Vernengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hillus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Wernicke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopinath","family":"Krishnamoorthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Rohde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias W.","family":"Pletz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Witzenrath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CAPNETZ-study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ayoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Prasse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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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\u2014SFB 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)\u2014T-CABS (01NVF23109), from the Federal Ministry of Health (BMG)\u2014PAIS Care (ZMII2-2524FSB105), from the Ministry of Defence\u2014NoVAP (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.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}