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

Abstract

Background.Diabetes is a major risk factor for skin and skin structure infection (SSSI), and the global burden of diabetics with SSSI is enormous. The more complex microbiology of diabetic foot infection (DFI) is well established, but it is not known whether microbiological etiology differs between diabetics and nondiabetics in other disease entities under the umbrella of complicated SSSI (cSSSI).Methods.This retrospective, population-based study included patients with cSSSI, and it was conducted in 2 Nordic cities with a low prevalence of antimicrobial resistance. In analyses, patients (N = 460) were separated into 3 groups: diabetics (n = 119), nondiabetics (n = 271), and patients with DFI (n = 70).Results.After exclusion of patients with DFI, there was no difference in the microbiological etiology or initial antimicrobial treatment of cSSSI between diabetics and nondiabetics. Gram-positive bacteria encountered 70% of isolations in diabetics and 69% in nondiabetics, and the empirical treatment covered initial pathogens in 81% and 86% of patients, respectively. However, diabetes was the only background characteristic in the propensity score-adjusted analysis associated with broad-spectrum antimicrobial use and longer antibiotic treatment duration. Patients with DFI had Gram-negative and polymicrobial infection more often than nondiabetics.Conclusions.These observations suggest that diabetics without DFI are not different in the causative agents of cSSSI, although they are more exposed to antimicrobial therapy of inappropriate extended spectrum and long duration. Broad-spectrum coverage was clearly needed only in DFI. A clear opportunity for antimicrobial stewardship was detected in the rapidly growing population of diabetic patients with cSSSI.

Antimicrobial stewardship opportunities among inpatients with diabetic foot infections: microbiology results from a tertiary hospital multidisciplinary unit

“…With rising rates of both diabetes and antimicrobial resistance, the need for antimicrobial stewardship in DFI is increasingly recognised . Among our inpatient cohort, we have shown that despite adherence to national guidelines, on the basis of subsequent culture results, excessive breadth of empiric antimicrobials with anti‐pseudomonal activity is frequent and potentially unnecessary.…”

Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis

“…Reports were informed by data collected since 1989 20 –2017. 21 22 The studies were conducted in Argentina, 16 Bangladesh, 23 24 Belgium, 25 Brazil, 26 27 Canada, 28 29 China, 21 30–32 Egypt, 33 Finland, 34 France, 35–37 Germany, 37 Greece, 38 Guyana, 22 India, 39 Italy, 37 40 Israel, 28 41–43 Japan, 44 Korea, 45 46 Madagascar, 47 Nepal, 48 Netherlands, 15 Norway, 49 Pakistan, 50 Poland, 51 Singapore, 20 52 53 Spain, 37 54–57 Sweden, 34 58 USA, 37 59–75 Taiwan 76 77 and Thailand. 78 …”

“…This was a cross-sectional hospital-based study, which analysed different antibiotics and bacteria ( table 3 ). 34 The available evidence is still inconclusive on whether people with T2DM have higher risk of complicated skin infections. Similarly, for other infection sites, it was not possible to reach strong conclusions or to conduct a meta-analysis, because the body of evidence was small or there was large heterogeneity ( tables 3 and 4 ).…”

“…20 -2017. 21 22 The studies were conducted in Argentina, 16 Bangladesh, 23 24 Belgium, 25 Brazil, 27 Canada, 28 29 China, 21 30-32 Egypt, 33 Finland, 34 France, [35][36][37] Germany, 37 Greece, 38 Guyana, 22 India, 39 Italy, 37 40 Israel, 28 41-43 Japan, 44 Korea, 45 46 Madagascar, 47 Nepal, 48 Netherlands, 15 Norway, 49 Pakistan, 50 Poland, 51 Singapore, 20 52 53 Spain, 37 54-57 Sweden, 34 58 USA, 37 59-75 Taiwan 76 77 and Thailand. 78 Evidence was mostly derived from cross-sectional (29 reports), 16 75 78 studies; fewer followed a cohort (five reports) 26 29 51 59 61 design (tables 1 and 2); of note one report contributed to both the cross-sectional and cohort count.…”

Low-Level Antibiotic Resistance among <i>Staphylococcus aureus</i> and Gram-Negative Pathogens from Infected Skin and Soft Tissues in Rural Kenya

“…Whereas Gram-positive bacteria like S. aureus and β-hemolytic Streptococci are the common causes of SSTIs, Gram-negative bacteria are also implicated especially in complicated SSTIs occurring in people with comorbidities [22]. We identified E. coli as the most common gram-negative species among SSTIs.…”