More research shows diabetes increases risk for SSI

Additional research points to an increased risk for surgical site infection in patients with diabetes, according to a meta-analysis published in Infection Control and Hospital Epidemiology.

“In our study, we found a significant association between diabetes and surgical site infection that was consistent across multiple types of surgeries and after controlling for BMI,” Infectious Disease News Editorial Board member Keith S. Kaye, MD, MPH, and colleagues wrote. “While we also confirmed an association between pre- and post-operative hyperglycemia and surgical site infection, history of diabetes remained a significant risk factor in meta-analyses of studies that controlled for hyperglycemia.”

Keith S. Kaye

In a meta-analysis of 14 prospective cohort studies, published earlier this year in the American Journal of Infection Control, Zhang and colleagues found that the crude RR of developing SSI in patients with diabetes was 2.02 (95% CI, 1.68-2.43). The studies had a pooled adjusted RR of 1.69 (95% CI, 1.3-2.13), showing a consistent increased risk for SSI in patients with diabetes.

In the present analysis, which included 94 studies published across 30 years, Kaye and colleagues found that the overall effect size for the association between diabetes and SSI had an OR of 1.53 (95% predictive interval [PI], 1.11-2.12). These studies extended across a broader range of procedures and included arthroplasties and breast, cardiac and spinal surgeries performed at U.S. hospitals after 1985, according to a press release.

SSI class, study design and patient BMI had no significant impact on the findings, according to the researchers.

“It is possible that diabetes is a marker for other conditions that may put a patient at risk of infection, including vascular changes and white blood cell dysfunction,” the researchers wrote. “In addition, the occurrence of perioperative hyperglycemia and subsequent immune suppression is affected by the complex contributions of factors in addition to the diabetic history of the patient, including physiologic stressors and exogenous glucose administration.”

Results suggested that patients with high blood glucose both before (OR = 1.88; 95% PI, 0.66-5.34) and after surgery (OR = 1.45; 95% PI, 0.77-3.04) were more likely than patients with normal blood glucose to develop SSI. In addition, the association between diabetes and SSI was higher for cardiac surgery than other surgeries (OR = 2.03; 95% PI, 1.13-4.05).

“This study is a first step in our efforts to identify patients at high risk of surgical site infections,” researcher Emily Toth Martin, PhD, MPH, assistant professor of epidemiology at the University of Michigan School of Public Health, said in the release. “We hope this research will lead to better strategies to lower the number of these infections nationwide.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.

References:

Martin ET, et al. Infect Control Hosp Epidemiol. 2015;doi:10.1017/ice.2015.249.

Zhang Y, et al. Am J Infect Control. 2015;doi:10.1016/j.ajic.2015.04.003.