Skin and Soft Tissue Infections and Associated Complications among Commercially Insured Patients Aged 0–64 Years with and without Diabetes in the U.S.

Abstract

IntroductionSkin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent of complications associated with these infections by diabetes status is not well established.MethodsUsing a very large repository database, we examined medical and pharmacy claims of individuals aged 0–64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis.ResultsWe identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and non-diabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people without diabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01).ConclusionsAmong persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization.

Retrospective Evaluation of Risk Factors and Response in Treatment among Hospitalized Patients with Lower-Extremity Cellulitis

“…İspanya'da yapılan bir çalışmada da benzer şekilde selülitli hastalarda %25 oranında diabetes mellitus görülmüştür (16). Amerika Birleşik Devletleri'nde yapılan bir çalışmada ise deri ve yumuşak doku enfeksiyonlarının komplikasyonlarının diyabetik hastalarda daha sık geliştiği gözlenmiştir (17).…”

Optical and structural properties of biological tissues under diabetes mellitus

“…In turn, the damage of nerve fibers (neuropathy) can lead to a neuropathic foot ulcer, the most severe skin injure arising when the reduced recovery capability of diabetic skin gives rise to infection, formation of gangrene, and, finally, leads to the amputation of lower extremities [58,59]. The authors of Ref.…”

“…These symptoms are manifestations of diabetes mellitus complications related to the hyperglycemia and glycation of proteins. There are many skin diseases facilitated by diabetes mellitus [19,58,59]. With age, structural changes occur in the skin, such as enlargement of pores, thinning of dermis, loss of bulk collagen, atrophy of blood vessels and flattening of dermis-epidermis junction [167].…”

“…In this connection, many papers are aimed at determining the concentration of free glucose in blood, interstitial fluid, and other fluids of the body [20][21][22][23][24][25][26][27][28][29][30], revealing the morphological changes in vital organs [10, 12, One third of all patients with diabetes mellitus have complications in the form of skin lesions, the most severe of them being the chronic ulcers that recover very slowly, thus increasing the risk of infection [19,[57][58][59]. Diabetes mellitus increases the risk of cardiovascular diseases, retinopathy that leads to blindness, neuropathy and nephropathy [8-13, 19, 31, 60-64].…”

Molecular factors involved in skin dryness in diabetic patients

“…Badania przeprowadzone w Australii i Stanach Zjednoczonych sugerują, że diabetycy są zagrożeni wyższym ryzykiem infekcji i powikłań spowodowanych infekcją [14,15]. Potwierdzeniem tych obserwacji są doświad-czenia z praktyki lekarskiej.…”