A Review of Acute Bacterial Dermo-hypodermatitis: Diabetes Mellitus Does Not Influence its Frequency or Prognosis

Abstract

Introduction: Acute bacterial dermo-hypodermatitis (DHAB) is an acute infection of the dermis and hypodermis that most often affects the lower limbs. Although diabetes mellitus has been identified as a risk factor for its development, recent studies have questioned this relationship. The aim of the present study was to compare clinical characteristics of inpatients with DHAB associated or not with diabetes mellitus.

Material & Methods: Prospective study of patients hospitalized at the Dermatology Department of the Coimbra Hospital and University Center with the diagnosis of DHAB between January and June 2018. The following parameters were evaluated: 1) demographic / biometric data - gender, age; body mass index; 2) clinical and evolutionary aspects - location of infection, interval between initial symptoms and diagnosis, history of a previous episode; previous diagnosis of diabetes mellitus; 3) laboratory abnormalities - leukocytosis, C-reactive protein (CRP), microorganism screening (blood, abscess pus, wound exudate, blister content); 3) therapy - duration of antibiotic therapy, need for second line therapy, length of hospitalization; 4) local (abscess, necrosis) or systemic complications (bacteremia, drug rash, deterioration of underlying disease and death). Data were analyzed with the SPSS software, mainly looking for the influence of diabetes mellitus on the different parameters evaluated. Statistical significance was set at p <0.05.

Results: We included 102 patients, 55 female (53.9%) and 47 male (46.1%), with a mean age of 68.6 ± 13.9 years. The lower limb was the most affected site (73.5%), followed by the upper limb (20.6%) and face (5.9%). In average there were 3.1 ± 2.5 days between initial symptoms and hospitalization. Twenty-four patients had a diagnosis of diabetes mellitus (23.5%), six under insulin treatment (25%). No statistically significant difference was found between the diabetic and non-diabetic group for gender, age, infection location, time from initial symptoms to hospitalization, neither in circulating leukocyte or CRP values. Microorganism screening (blood, abscess pus, wound exudate, blister content) was positive in 2/8 diabetics (25%) and 15/39 non-diabetics (38.5%) (p=0.138), with the same type of microorganism isolated in both groups. Initial antibiotic therapy - cefoxitin plus clindamycin in 64.7% - was replaced in one non-diabetic and 10 diabetic patients (p=0.451) and the total duration of antibiotic treatment and hospitalization between groups was similar. Local complications occurred in 3 diabetics (12.5%) and 15 non-diabetics (19.2%), and systemic complications in 4 diabetics (16.7%) and 12 non-diabetics (15.4%), p=0.553 and p=1.000, respectively.

Conclusion: The present study shows that diabetes mellitus in hospitalized patients diagnosed with DHAB is not associated with a worse prognosis, namely in which concerns need for second line antibiotic therapy, longer hospitalization or local/systemic complications.