This article is more than 5 years old. Information may no longer be current.
Researchers identify significant SSI risk in patients with diabetes
Click Here to Manage Email Alerts
A recent meta-analysis published in the American Journal of Infection Control confirmed that patients with diabetes are at significant risk for surgical site infection.
“Considering the consistent findings of increased SSI risk associated with diabetes across a number of prospective cohort studies and the reliability and robustness of our meta-analysis, we strongly recommend that future studies focus on the plausible causal mechanisms,” Yu Zhang, MPH, from the Guangdong Academy of Medicine Science and Guangdong General Hospital in Guangzhou, China, and colleagues wrote in their study. “Intervention studies concerning perioperative blood glucose control are also warranted to confirm this observed association to elucidate whether the association is causal.”
Zhang and colleagues performed a literature search in the PubMed, Embase and Web of Science databases of studies with a prospective cohort design with a calculated OR, RR, or HR of patients with diabetes developing surgical site infections (SSI). They identified 14 prospective cohort studies with 91,094 participants, with the incidence of SSI ranging from 0.72% to 17%.
The researchers found that the crude RR of developing SSI was 2.02 (95% CI, 1.68–2.43); however, they noted significant study heterogeneity in their meta-analysis, at 56.5%. While seven of the 14 included studies did not have adjusted RR, the studies had a pooled adjusted RR of 1.69 (95% CI, 1.3–2.13), showing a consistent increased risk for patients with diabetes to develop SSIs.
A subgroup analysis of heterogeneity showed that each study had consistent and statistically significant results, and stratified analyses identified sample size, diabetes case ascertainment method and the number of adjusted confounders as potential sources of heterogeneity, according to the researchers. Sensitivity analysis also demonstrated the “robustness of the result,” they said. – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopIt is a well-recognized fact that patients with diabetes suffer from bacterial infections more often than nondiabetic patients, but the magnitude of risk increase has been undefined. In a recent study, the risk for hospitalizations due to bacterial infections correlated with the degree of diabetic nephropathy. The risk ratio ranged from 1.23 in patients with microalbuminuria to 11.2 in dialysis patients as compared with nondiabetic patients (Simonsen JR, et al, BMJ Open Diab Res Care. 2015;doi:10.1136/bmjdrc-2014-000067).
Asko Järvinen
In the abovementioned study, Zhang and colleagues from Guangzhou, China, investigated the impact of diabetes on the risk for SSIs using published data from more than 90,000 subjects. Meta-analysis of 14 independent cohort studies revealed that patients with diabetes had a nearly twofold higher risk for SSIs compared with nondiabetic patients. The study points out an important fact — patients with diabetes have significantly increased risk for SSI. However, the risk ratio of SSI, as compared with nondiabetic patients, has still to be defined in specific subgroups of diabetes (eg, type 1 diabetes vs. type 2 diabetes), and in people with variable degrees of diabetic nephropathy and other complications. The findings by Zhang and colleagues may be utilized when the risks for operative procedures are weighed up.
Markku Lehto
Asko Järvinen, MD, PhD
Division of infectious diseases, Inflammation Center
Helsinki University Central Hospital, Helsinki, Finland
Markku Lehto, PhD
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital
Research Programs Unit, Diabetes and Obesity, University of Helsinki
Click Here to Manage Email Alerts