Jenkins Timothy C, Knepper Bryan C, Jason Moore S, Saveli Carla C, Pawlowski Sean W, Perlman Daniel M, McCollister Bruce D, Burman William J
Department of Medicine, Denver Health, Denver, Colorado; Division of Infectious Diseases, Denver Health, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado.
J Hosp Med. 2014 Dec;9(12):788-94. doi: 10.1002/jhm.2267. Epub 2014 Sep 30.
Among diabetics, complicated skin infections may involve gram-negative pathogens; however, the microbiology of cellulitis and cutaneous abscess is not well established.
To compare the microbiology and prescribing patterns between diabetics and nondiabetics hospitalized for cellulitis or abscess.
Secondary analysis of 2 published retrospective cohorts.
SETTING/PATIENTS: Adults hospitalized for cellulitis or abscess, excluding infected ulcers or deep tissue infections, at 7 academic and community facilities.
Microbiological findings and antibiotic use were compared among diabetics and nondiabetics. Multivariable logistic regression was performed to identify factors associated with exposure to broad gram-negative therapy, defined as receipt of at least 2 calendar days of β-lactamase inhibitors, second- to fifth-generation cephalosporins, fluoroquinolones, carbapenems, tigecycline, aminoglycosides, or colistin.
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 nondiabetics (P = 0.59); aerobic gram-negative organisms were isolated in 7% and 12%, respectively (P = 0.28). Overall, diabetics were more likely than nondiabetics to be exposed to broad gram-negative therapy (54% vs 44% of cases, P = 0.02). By logistic regression, diabetes mellitus was independently associated with exposure to broad gram-negative therapy (odds ratio: 1.66, 95% confidence interval: 1.15-2.40).
In cases of cellulitis or abscess associated with a positive culture, gram-negative pathogens were not more common among diabetics compared with nondiabetics. However, diabetics were overall more likely to be exposed to broad gram-negative therapy suggesting this prescribing practice may not be not warranted.
在糖尿病患者中，复杂的皮肤感染可能涉及革兰氏阴性病原体；然而，蜂窝织炎和皮肤脓肿的微生物学情况尚未完全明确。
比较因蜂窝织炎或脓肿住院的糖尿病患者和非糖尿病患者的微生物学情况及用药模式。
对2个已发表的回顾性队列进行二次分析。
地点/患者：在7家学术和社区医疗机构中，因蜂窝织炎或脓肿住院的成年人，不包括感染性溃疡或深部组织感染患者。
比较糖尿病患者和非糖尿病患者的微生物学检查结果及抗生素使用情况。进行多变量逻辑回归分析，以确定与接受广泛革兰氏阴性治疗相关的因素，广泛革兰氏阴性治疗定义为接受至少2个日历日的β-内酰胺酶抑制剂、第二代至第五代头孢菌素、氟喹诺酮类、碳青霉烯类、替加环素、氨基糖苷类或黏菌素治疗。
在770例蜂窝织炎或脓肿患者中，167例（22%）患有糖尿病。在38%培养结果呈阳性的病例中，90%的糖尿病患者和92%的非糖尿病患者分离出需氧革兰氏阳性菌（P = 0.59）；需氧革兰氏阴性菌的分离率分别为7%和12%（P = 0.28）。总体而言，糖尿病患者比非糖尿病患者更有可能接受广泛革兰氏阴性治疗（分别为54%和44%的病例，P = 0.02）。通过逻辑回归分析，糖尿病独立与接受广泛革兰氏阴性治疗相关（比值比：1.66，95%置信区间：1.15 - 2.40）。
在培养结果呈阳性的蜂窝织炎或脓肿病例中，与非糖尿病患者相比，革兰氏阴性病原体在糖尿病患者中并不更常见。然而，糖尿病患者总体上更有可能接受广泛革兰氏阴性治疗，这表明这种用药做法可能没有依据。
