Sharma K, et al. – In this study, researchers deliber that diabetes worsens the burden of disease, and that diabetic inpatients may benefit from stronger glycemic control. In context of the findings, diabetes exacerbates the burden of disease of surgical hand infections, as evidenced by more–proximal locations and deeper involved anatomy at presentation, broader microbiology, increased need for repeat drainage, and longer inpatient LOS, when compared to non–diabetics. Moreover, diabetic surgical hand infections should have fungal cultures sent from first drainage.

Methods

• Researchers carried out a prospective cohort study recruiting diabetic and non–diabetic surgical hand infection patients over three years.
• They recorded patient background, clinical presentation, pathogenic microbiology, and surgical triage variables.
• In this study, surgical triage included setting of first drainage (bedside vs. operative) and level of care (outpatient vs. inpatient).
• Thereafter, diabetic factors included baseline glycosylated hemoglobin (HbA1c), blood glucose (BG) at presentation, and average value of inpatient BG measurements.
• They characterized consistent with existing guidelines, poor baseline control as HbA1c > 9.0%, and poor inpatient control as average BG > 180.
• Clinical outcomes included need for repeat drainage and inpatient length–of–stay (LOS), with prolonged LOS defined as > 75th percentile.
• In this multivariate logistic regression, they evaluated the impact of diabetic factors on outcomes.

Results

• In this analysis, 322 patients were accrued: 76 diabetic and 246 non–diabetic.
• The data showed that diabetics were more likely to be older (median 54 vs. 37 years, P = 0.05).
• Nevertheless, it was demonstrated that poor inpatient glycemic control predicted both need for repeat drainage (OR3.16, P = 0.05) and prolonged LOS (OR4.65, P < 0.01). (Fig. 63–1, Table 63–1).