Gram-Negative Bacilli SSTIs on the Rise in Patients With Diabetes

A number of upward epidemiologic trends and associated risk factors for mortality seen in patients with diabetes.

A new study found an increasing trend in the proportion of people with diabetes who have Gram-negative bacilli (GNB) skin and soft tissue infections (SSTIs) and an increase in associated mortality. Findings from the study were published in Diabetes Care.

Patients with diabetes who were admitted to a single center between 1996 and 2016 with a blood stream infection related to an SSTI were included in the study. A total of 7202 cases of bacteremia occurred in patients with diabetes, which represented approximately 23.7% of all cases of bacteremia observed during the study period. A significant increase in cases occurred from 1996 to 2000 to 2011 to 2016 (17.7% vs 28.3%, respectively; P <.001).

The researchers observed an upward trend between 1996 and 2000 and 2011 and 2016 in the prevalence of GNB SSTIs (14.3% vs 40.6%, respectively; P =.020), previous use of antibiotics (14.3% vs 44.9%, respectively; P =.003), and the proportion of GNB resistant to antibiotics (0% vs 20.3%, respectively; P =.100). Mortality was higher for patients with GNB SSTIs vs patients with Gram-positive cocci SSTIs (32.4% vs 13.8%, respectively; P =.002). The only significant risk factor for mortality in the adjusted analysis was infection caused by GNB (adjusted odds ratio, 2.73; 95% CI, 1.11-6.70; P =.028).

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Limitations of the study include its retrospective nature as well as the inclusion of only patients from a single center.

Because of the increase in GNB infections, particularly those resistant to frequently used antibiotics, the researchers suggest “appropriate empirical coverage is mandatory, whether in patients with SSTIs and severe systemic manifestations or suspicion of bacteremia.”

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Benavent E, Murillo O, Grau I, et al. The impact of Gram-negative bacilli in bacteremic skin and soft tissue infections among patients with diabetes [published online May 21, 2019]. Diabetes Care. doi:10.2337/dc18-2294