Date of Conferral

7-24-2026

Date of Award

July 2026

Degree

Ph.D.

School

Health Sciences

Advisor

Naoyo Mori

Abstract

Hospital-acquired infections (HAIs) remain a major cause of preventable morbidity, mortality, and healthcare utilization among hospitalized patients. Limited research has examined the relationship between diabetes and HAIs in Puerto Rican populations. The purpose of this quantitative cross-sectional study was to examine the prevalence of type 2 diabetes mellitus (T2DM) and its association with HAI characteristics and hospitalization outcomes among patients in southern Puerto Rico. The chronic care model provided a framework for evaluating whether diabetes status, geographic location, and substance use were associated with outcomes. Data were obtained through retrospective review of electronic health records from N = 846 patients with confirmed HAIs and analyzed using descriptive statistics, bivariate analyses, logistic regression, and Kaplan-Meier analyses. Findings showed that diabetes was prevalent (56.9%) among patients with HAIs and was associated with greater comorbidity burden, higher frequencies of ventilator-associated pneumonia and polymicrobial infections, increased intensive care unit utilization, longer hospital stays, and poorer clinical outcomes. Geography, smoking and alcohol history were not consistently associated with outcomes after adjustment for covariates. Age (aOR: 1.016–1.018), male sex (aOR: 1.597–1.725), and comorbidity burden (aOR: 1.156–1.204) emerged as independent predictors of several infection outcomes. These findings suggest that, among the studied population, diabetes contributes more strongly to the severity and consequences of HAIs than to the occurrence of specific infection types. The results may help inform infection prevention and quality improvement strategies aimed at reducing healthcare disparities among vulnerable populations.

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