Etiology of SSSIs similar in patients with, without diabetes

Patients with diabetes had microbiological etiologies in complicated skin and skin structure infections similar to that of patients without diabetes, according to findings published in Open Forum Infectious Diseases.

“Gram-positive cocci, particularly streptococci and Staphylococcus aureus, are the major causative organisms of [skin and skin structure infections (SSSIs)], but gram-negative rods and anaerobic bacteria are frequently detected in patients with diabetic foot infection,” Iiro P. Jääskeläinen, PhD, of the department of infectious diseases at Helsinki University Central Hospital, Finland, and colleagues wrote. “Studies evaluating the microbiological etiology of skin and skin structure infections (excluding diabetic foot infection) separately among diabetics and nondiabetics are scarce.”

Jääskeläinen and colleagues performed a retrospective population-based cohort study with patients from Helsinki, Finland and Gothenburg, Sweden, chosen because of their similar sizes and lack of antimicrobial resistance. Patients were treated for complicated SSSIs at either Helsinki University Central Hospital, Helsinki City Hospital or Sahlgrenska University Hospital in Gothensburg from 2008 to 2011. Patients were divided into three groups: those with diabetes (n = 119), those without diabetes (n = 271) and those with diabetic foot infection (n = 70).

Although the researchers did not find significant differences between patients with and without diabetes regarding microbiological etiology, they reported that broad-spectrum antibiotics were used more often in patients with diabetes than those without diabetes (42% vs. 28%; OR = 1.83; P = .008). Jääskeläinen and colleagues reported several other factors associated with broad-spectrum therapy: invasive surgery within the previous 3 months (OR = 2.79; P = .001), admission to an ICU (OR = 2.65; P = .001), bacteremia (OR = 2.55; P = .002) and polymicrobial etiology of infection (OR = 3.76; P < .001).

Patients with diabetes also had longer total duration of treatment than patients without diabetes, the researchers wrote. Patients who were being treated for diabetic foot infections had more gram-negative bacteria and polymicrobial infections than patients who did not have diabetes.

“These observations offer a clear opportunity for antimicrobial stewardship in the vulnerable ever-growing population of diabetic patients,” the researchers wrote. – by Andy Polhamus

 

Disclosure: Jääskeläinen reports financial support from Gilead Sciences for attending symposia. Please see the full study for a list of all other authors’ relevant financial disclosures.