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Master Thesis

Étude descriptive des patients diabétiques hospitalisés pour plaie de pieds au CHU de Bordeaux : lien infection-contrôle glycémique et devenir

Abstract : Introduction: poor glycemic control favors infections in diabetic subjects, but whether hyperglycaemia favors diabetic foot infections that critically complicate Diabetic Foot Ulcer (DFU) remains to be ascertained. Our study aimed to search whether baseline HbA1c differed according to the presence of infection in subjects hospitalized for DFU. Methods: we compared the characteristics and outcomes of patients who were admitted in our ward from 2011 to 2014 for a DFU, according to the presence of infection, based on their clinical characteristics: purulence, erythema, pain, tenderness, warmth and/or induration. Results: one hundred and forty-three subjects were admitted for a DFU. They were mainly men (72.9%), with a mean age of 64±11 years, mainly Type 2 (78.8%) with a mean duration of diabetes of 20±13 years. Most ulcers were unique (67.8%), located on the toes (56.3%) or metatarsal heads (25.9%), their duration before admission was 38 days (14-90). During follow-up (26 months (10-54)), 94 subjects had a recurrent DFU (65.7%) and 15 subjects died (11.7%), their initial HbA1c did not differ significantly from that of others. Ninety subjects (62.9%) had infected ulcers, including 54 osteomyelitis (37.8%). Their C-reactive protein levels were higher compared to that of subjects without infection (p<0.001). As compared to non-infected DFUs, infected DFUs led to a doubled hospital stay (21 (11-34) vs 11 (6-14) days, p<0.001), double-time to healing (17 (9-31) vs 9 (5-22) weeks, p<0.05), twice the rates of readmissions (33.3 vs 17%, p<0.05), and more lower-limb revascularization procedures (38.9% vs 13.2%, p<0.001) and amputations (36.7% vs 1.9%, p<0.001). HbA1c levels were significantly higher for patients with infected DFUs (8.8±1.9% vs 8.1±1.8%, p<0.05), and remained as such after adjustment for age, gender, and peripheral arterial disease (OR: 1.296, 95%CI: 1.045-1.608). Conclusion: infection is critical for the short-term prognosis of DFU and relates to glucose control.
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Amélie Simoneau. Étude descriptive des patients diabétiques hospitalisés pour plaie de pieds au CHU de Bordeaux : lien infection-contrôle glycémique et devenir. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02558597⟩

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