Transcript Diabetic`s infections - MGSD - Mediterranean Group for the Study of

Diabetic’s infections
(100 cases)
C. RAGGABI; H. IRAQI; F. AJDI;
MH GHARBI; A. CHRAIBI.
Endocrinology & Diabetology Department
CHU Avicenne ; Rabat – Morocco.
INTRODUCTION:
Diabete mellitus is a complex chronic disease
PANDEMY!!!
Particularities of the diabetic’s infection:

It’s frequency

Subjects to infections

Metabolic failure’s risk

diagnosis and therapeutics' difficulties
The aim of our study is:
To determine:
 clinical and therapeutical aspects

acute infection’s and their evolution in our patients
Evaluate the quality of treatment in our Moroccan context.
MATERIAL & METHODS(1)


retro-prospective study
100 diabetic patients hospitalized in our department during two years
from January 2005 to December 2006.

Hospitalisation reason:
- Unstable Glycaemia
- ketosis failure.
The parameters we studied:
 anthropometric Criteria
 The localisation of infection
 Glycaemia balance
 Metabolic repercussions
 Treatment
 Evolution
MATERIAL & METHODS(2)

The female ratio is predominant; with sex. ratio = 3

Age rate = 44,05 years +/-15.6.
Type 2
Type 1
Gestationnel
1
Type 2
56%
Type 1
42,60%
Gestationnel
1,40%
RESULTS (1)
infe ction proportion in our diabe tic
patie nts
no
Infection
in fectio n
75%
25%


Infectious episode was found in 75% of diabetics
All patients (100%) were hyperglycaemic during the episode of the
infection :

Fasting glucose rate= 2.52 g/l +/- 1.32

HbA1c average = 9.4% +/- 2.07.
RESULTS (2)
Infection was found in:
49%
50%
Examen clinique systématique
décompensation cétosique
RESULTS (3)
The localisation of infections
cutaneous
42,66%
Urinary
30,66%
ORL Genital
10,35% 9,33%
Broncho
pulmon . 7%
RESULTS (4)
Treatment and evolution

Antibiotics Prescription:
After antibiogram
Unknown antibiogram
2.67%
97.33%

Favourable evolution for 98.60 % of our patients

Estimated on the clinical & biological criteria and the regression
of the metabolic trouble .

One case of recurrence of the cutaneous abscess one week after
being discharged.
DISCUSSION
Cutaneous infection (1)

The diabetic infections prevalence according to international
series ( 20 – 35% ) :
M. MOHAMMADI
(1996)
117 cases
S. AMAL
(2004)
105 cases
M. OUEDRAOGO
(2000)
85 cases
H. GIN
(1993)
208 cases
Our SERIE
(2006)
100 cases
17.8%
20%
29.4%
30%
42%



under estimated prevalence because (*):
There isn’t enough motivation for consultation
Treated in dermatology department
(*)S. BENAMOR « Manifestations cutanéo-muqueuses du Diabète » EMC – 2002.
Cutaneous infection(2)





+++ mycosic infections
(87 %):
Intertrigo
Onychomycosis
Mycosis
the mycological taking
of nails was made only
in one case.




- our studyBacterial infections : 13%
2 erysipelas
2 abscess
germs in cause were not
identified (the pyoculture
wasn’t decisive in both
cases of abscess).
Urinary infection (1):


20 to 40% of diabetic infections :
M.
MOHAMMADI
(1996)
117 cases
R.
GIRARD
(2006)
153 cases
M.
OUEDRAOGO
(2000)
85 cases
H. GIN
(1993)
208 cases
Our SERIE
(2006)
100 cases
10.58%
22.4%
17.65%
35%
30.66%
The cytobacteriological trial was decisive only in 20 % of the patients
presenting urinary signs, while it found germs in cause in 60 % of the
cases for the others series*
*M. OUEDRAOGO et al. – Médecine d’Afrique noire - 2000
*R GIRARD et al. – Médecine et Maladies infectieuses 2006
Urinary infection (2):

Germs in cause of the urinary infections were:
Our study
C. Pagnoux (1997)
H. Gin (1993)
E. coli
33%
28%
30%
Klebsiella
12%
20%
24%
4%
12%
16%
Candida
1.8%
3%
_
Not identified
49.2%
37%
30%
Pseudomonas

This corresponds to literature data **
**H. GIN « Infection et diabète » Rev. Méd; Interne -1993.
** C. PAGNOUX Rev Méd; Interne – 1997.
Broncho-pulmonary infection:



Represents only 7% of the infections in our serie:
M. OUEDRAOGO
(2000)
85 cases
M. MOHAMMADI
(1996)
117 cases
Our SERIE
(2006)
100 cases
47.06%
63.1%
7%
+++ non specifical germs.
No case of pulmonary tuberculosis infection, versus 36% in other
series(*).
M. Mohammadi et al. « Mortalité diabétique dans un service de médecine » Médecine du Maghreb – 1996.
Others infections :
ORL’s infection :
 Rare: 5 à 15% depending on the series(*)
 Our serie: 10%
 Otitis (5 cas)+++, sinusitis (3 cas).
Genital infection
 +++ 9% (4-6%)*.
 Dominated by external uro-genital candidosis.
H. GIN « Infection et diabète » Rev. Méd; Interne -1993.
C. PAGNOUX Rev Méd; Interne – 1997.
CONCLUSION
 The infection remains among the most frequent acute
complications of the diabetes.
It is specially represented by :
 the urinary and cutaneous localisations found in the
badly equilibrated diabetes.
 These infections should be watched closely end
regularely by :
 Trying hard to identify the germs in cause
 educating the patient and his relatives to avoid the
acute metabolic failure
 to assure a more rational care.