The impact of diabetes in patients with necrotizing soft tissue infections

Background: Given the association of diabetes with necrotizing soft tissue infections (NSTIs) and hyperglycemia with mortality in critically ill patients, this study investigates the impact of diabetes and hyperglycemia in NSTI patients. Methods: This is a retrospective review of NSTI patients at LBJ General Hospital between January 1995 and December 2002, assessing infectious morbidity, mortality, and length of hospital stay. Results: There was a trend towards increased infectious complications, defined as a hospital-acquired (not present within 48 h of presentation) infection at a secondary site, amongst diabetic patients (RR 2.1, 95% CI 0.7-6.8) and patients with admission hyperglycemia greater than 200 mg/dL (OR 1.9, 95% CI 0.7-5.7) but not with admission hyperglycemia greater than 120 mg/dL (OR 1.6, 95% CI 0.3-8.7). Patients with an infectious complication had a longer hospital stay (median, interquartile range [IQR]; 36, 30-44 days vs. 10, 7-20 days, p < 0.001), increased mortality (29% vs. 7%, p = 0.05), and poorer outcome defined as death, amputation, or hospital stay exceeding the 75th percentile for length of stay (79% vs. 20%, p < 0.001). Conclusions: Diabetes mellitus and admission hyperglycemia may increase infectious complications in NSTI patients, predicting a longer and more complicated hospital course. Further study is required to define the optimal metabolic target in this patient population.