Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess

Abstract

Background Among diabetics, complicated skin infections may involve gram-negative pathogens; however, the microbiology of cellulitis and cutaneous abscess is not well-established. Objective To compare the microbiology and prescribing patterns between diabetics and non-diabetics hospitalized for cellulitis or abscess Design Secondary analysis of two published retrospective cohorts Setting/Patients Adults hospitalized for cellulitis or abscess, excluding infected ulcers or deep tissue infections, at 7 academic and community facilities Methods Microbiological findings and antibiotic use were compared among diabetics and non-diabetics. Multivariable logistic regression was performed to identify factors associated with exposure to broad gram-negative therapy, defined as receipt of at least two calendar days of β-lactamase inhibitors, 2nd – 5th generation cephalosporins, fluoroquinolones, carbapenems, tigecycline, aminoglycosides, or colistin. Results Of 770 total patients with cellulitis or abscess, 167 (22%) had diabetes mellitus. Among the 38% of cases with a positive culture, an aerobic gram-positive organism was isolated in 90% of diabetics and 92% of non-diabetics (p = .59); aerobic gram-negative organisms were isolated in 7% and 12%, respectively (p = .28). Overall, diabetics were more likely than non-diabetics to be exposed to broad gram-negative therapy (54% vs 44% of cases, p = .02). By logistic regression, diabetes mellitus was independently associated with exposure to broad gram-negative therapy (OR 1.66, 95%CI 1.15 – 2.40). Conclusion In cases of cellulitis or abscess associated with a positive culture, gram-negative pathogens were not more common among diabetics compared with non-diabetics. However, diabetics were overall more likely to be exposed to broad gram-negative therapy suggesting this prescribing practice may not be not warranted.

Microbiological Etiology and Treatment of Complicated Skin and Skin Structure Infections in Diabetic and Nondiabetic Patients in a Population-Based Study

“…In our study, Gram-positive aerobic bacteria accounted for the vast majority of microbiological diagnosis (diabetics 70% and nondiabetics 69%), which is consistent with the study by Jenkins et al [13] and also to other studies in patients with cSSSI [7, 8, 18, 19]. In light of this finding, the observation of more frequent use of broad-spectrum antibiotics among diabetics in our study and in the study by Jenkins et al [13] is remarkable. More frequent broad-spectrum use was not observed in either study in the empirical antibiotic choice, but the antibiotics were changed to broad-spectrum more often among diabetics than in nondiabetics.…”

“…In our study, the median total duration of antimicrobial treatment was 21 days in diabetics and 14 days in nondiabetics, compared to 13 and 12 days detected by Jenkins et al [13], respectively. Because the severity of infection was not similar in these studies, the total treatment durations cannot be compared between them.…”

“…Diabetic patients have differed from nondiabetics in many aspects both in our cSSSI population and previous studies with less severe SSSI [13, 15–17]. Diabetics have been older, more likely to have infection classified as cellulitis or infection localized into a lower extremity, and had chronic renal failure more often but less injection drug abuse [13, 15–17].…”

A potential benefit from infectious disease specialist and stationary ward in rational antibiotic therapy of complicated skin and skin structure infections

“…To the best of our knowledge, the effect of Infectious Disease Specialist based treatment on the outcome of patients with cSSSI has not been studied. Infectious Disease Specialist consultation has been shown to improve the treatment of Staphylococcus aureus bacteraemia, but in SSSI it was identified as an independent risk factor for broad-spectrum antimicrobial therapy [27,28]. The time from diagnosis to the first modification of intravenous antibiotic treatment to another intravenous agent was almost statistically significantly longer in Gothenburg (median 4 days) than in Helsinki (3 days, p = 0.0507).…”

ANTIBACTERIAL ACTIVITY of COMBINATION COLD PLASMA and PARIJOTO (Medinilla speciosa) against Staphylococcus aureus and Pseudomonas aeruginosa on DIABETIC ULCER

“…Ulcers can cause inflammation or make the tissue damaged (Gardner dan Frantz RA, 2012). In this condition, Gram-positive substances such as Staphylococcus aureus and Gramnegative bacteria such as Pseudomonas aeruginosa can produce biofilms (Jenkins et al, 2014). Treatment of ulcers with bacterial infections is recommended by giving antibiotics.…”