Authors: B A Lipsky Y P Tabak R S Johannes L Vo L Hyde J A Weigelt
Publish Date: 2010/02/10
Volume: 53, Issue: 5, Pages: 914-923
Abstract
Using a clinical research database from CareFusion we identified 3030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007 We classified the culture isolates and analysed their association with the anatomic location of infection mortality length of stay and hospital costsThe only culture isolate with a significantly increased prevalence was methicillinresistant Staphylococcus aureus MRSA prevalence for infection of the foot was increased from 116 to 219 p 00001 and for nonfoot locations from 140 to 246 p = 0006 Patients with nonfoot vs foot infections were more severely ill at presentation and had higher mortality rates 22 vs 10 p 005 Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa OR 31 a monomicrobial culture with other gramnegatives OR 89 greater illness severity OR 19 and being transferred from another hospital OR 51 These factors and need for major surgery were also independently associated with longer length of stay and higher costsAmong diabetic patients hospitalised with SSTI from 2003 to 2007 only MRSA increased in prevalence Patients with nonfoot vs foot infections were more severely ill Independent risk factors for increased mortality rates length of stay and costs included more severe illness transfer from another hospital and wound cultures with Pseudomonas or other gramnegativesSkin and soft tissue infections SSTIs are leading causes of morbidity and occasionally mortality in persons with diabetes mellitus 1 2 3 4 Various complications of diabetes eg sensory neuropathy vascular insufficiency immunopathy and metabolic perturbations can predispose these patients to infections 5 6 SSTIs are more common and more severe in diabetic than in nondiabetic patients and constitute a leading cause of hospitalisation 7 The risk of SSTIrelated hospitalisation is more than twice as high in diabetic than in nondiabetic patients 8 Diabetes is independently associated with increased emergency department visits for SSTIs 9 longer hospital stays 8 and infectionattributable death 10 11 The rising prevalence of diabetes 7 12 is likely to cause increasing numbers of diabetesrelated SSTIs in hospitalised patients
Keywords: