Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections

Abstract

Diabetes mellitus affects 284 million adults worldwide and is increasing in prevalence. Accelerated atherosclerosis in patients with diabetes mellitus contributes an increased risk of developing cardiovascular diseases including peripheral vascular disease (PVD). Immune dysfunction, diabetic neuropathy and poor circulation in patients with diabetes mellitus, especially those with PVD, place these patients at high risk for many types of typical and atypical infections. Complicated skin and soft-tissue infections (cSSTIs) are of particular concern because skin breakdown in patients with advanced diabetes mellitus and PVD provides a portal of entry for bacteria. Patients with diabetes mellitus are more likely to be hospitalized with cSSTIs and to experience related complications than patients without diabetes mellitus. Patients with PVD requiring lower extremity bypass are also at high risk of surgical site and graft infections. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative pathogen in cSSTIs, and may be a significant contributor to surgical site infections, especially in patients who are colonized with MRSA on hospital admission. Patients with cSSTIs and diabetes mellitus or PVD experience lower clinical success rates than patients without these comorbidities, and may also have a longer length of hospital stay and higher risk of adverse drug events. Clinicians should be vigilant in recognizing the potential for infection with multi-drug-resistant organisms, especially MRSA, in these populations and initiating therapy with appropriate antibiotics.

Whole-genome expression analyses of type 2 diabetes in human skin reveal altered immune function and burden of infection

“…In addition, 152 DE genes in the skin (FDR < 0.2), which are also expressed in the muscle, showed a consistent T2DM-associated expression changes between the muscle and skin (Supplementary Figure 1). These results indicated the burden of infection in both human skin and muscle of T2DM, and are consistent with high rates of skin and soft-tissue infections observed in patients with type 2 diabetes [21]. …”

“…A number of studies have shown that patients with T2DM are associated with a higher risk of infectious diseases [21–24]. About fifty percent of the diabetic patients involved in Shah's study had at least one hospitalization or physician claim for infection in each cohort year [23].…”

Utilizing V Y fasciocutaneous advancement flaps for vulvar reconstruction

“…The presence of both diabetes and HIV have been shown to lead to infectious complication. (Dryden et al, 2015; Knapp, 2013). It is, however, unclear why black race led to an increase in infectious complications.…”

Ectima gangrenoso secundario a Staphylococcus aureus

“…En ellos, las soluciones de contigüidad con la consiguiente pérdida de la barrera cutánea permiten la entrada fácil de bacterias patógenas. Además, está demostrado que la DM y la EVP aumentan el riesgo de colonización por SARM en pacientes hospitalizados 11 . En el caso de nuestra paciente, si bien no contaba con los factores de riesgo descritos para el desarrollo de EG, presentaba otras co-morbilidades que favorecen el desarrollo de infecciones cutáneas complicadas: como DM mal controlada, EVP y ERC.…”