The Impact Of Gram-Negative Bacilli In Bacteremic Skin And Soft Tissue Infections Among Patients With Diabetes

Skin and soft tissue infections (SSTIs) are common and may be more severe in patients with diabetes. In particular, the development of diabetic foot ulcers facilitates diabetic foot infections (DFIs), which are generally not included in SSTI classifications (1). In these situations, gram-negative bacilli (GNB) may have an impact on the etiology of severe SSTIs. We aimed to analyze the GNB etiology, epidemiologic trends, and risk factors for mortality among a large cohort of adult patients with diabetes attended in our hospital (1996–2016) with bloodstream infections from an SSTI source (1). Cases with nosocomial acquisition or due to a sacral decubitus ulcer were excluded. Out of 30,363 episodes of bacteremia, 7,202 (23.7%) occurred in patients with diabetes; this proportion increased over time from 17.7% in 1996–2000 to 28.3% in 2011–2016 ( P < 0.001). Among bacteremic episodes in patients with diabetes, 247 (3.4%) were secondary to SSTIs, of which 223 were analyzed (Table 1). The most common clinical form was cellulitis ( n = 184, 82.5%). DFIs represented 25% of cases (with abscesses in 23%), of which 41.8% required surgery (amputation, 43.5%). View this table: Table 1 Clinical characteristics of the studied cohort and differences between patients with an infection due to GNB, GPC, or mixed …