Diabetic’s infections (100 cases)

1. Diabetic’s infections(100 cases) C. RAGGABI; H. IRAQI; F. AJDI; MH GHARBI; A. CHRAIBI. Endocrinology & Diabetology Department CHU Avicenne ; Rabat – Morocco.

2. INTRODUCTION: Diabete mellitus is a complex chronic disease PANDEMY!!! Particularities of the diabetic’s infection: • It’s frequency • Subjects to infections • Metabolic failure’s risk • diagnosis and therapeutics' difficulties The aim of our study is: To determine: • clinical and therapeutical aspects • acute infection’s and their evolution in our patients Evaluate the quality of treatment in our Moroccan context.

3. MATERIAL & METHODS(1) • retro-prospective study • 100 diabetic patients hospitalized in our department during two years from January 2005 to December 2006. • Hospitalisation reason: - Unstable Glycaemia - ketosis failure. The parameters we studied: • anthropometric Criteria • The localisation of infection • Glycaemia balance • Metabolic repercussions • Treatment • Evolution

4. MATERIAL & METHODS(2) • The female ratio is predominant; with sex. ratio = 3 • Age rate = 44,05 years +/-15.6.

5. RESULTS (1) • Infectious episode was found in 75% of diabetics • Allpatients (100%) were hyperglycaemicduring the episode of the infection : • Fasting glucose rate= 2.52 g/l +/- 1.32 • HbA1c average = 9.4% +/- 2.07.

6. RESULTS (2)Infection was found in:

7. cutaneous 42,66% Urinary 30,66% ORL Genital Broncho 10,35% 9,33% pulmon . 7% RESULTS (3)The localisation of infections

8. RESULTS (4)Treatment and evolution • Antibiotics Prescription: • Favourable evolution for 98.60 % of our patients • Estimated on the clinical & biological criteria and the regression of the metabolic trouble . • One case of recurrence of the cutaneous abscess one week after being discharged.

9. DISCUSSIONCutaneous infection (1) • The diabetic infections prevalence according to international series ( 20 – 35% ) : • under estimated prevalence because (*): • There isn’t enough motivation for consultation • Treated in dermatology department (*)S. BENAMOR « Manifestations cutanéo-muqueuses du Diabète » EMC – 2002.

10. +++ mycosic infections(87 %): Intertrigo Onychomycosis Mycosis the mycological taking of nails was made only in one case. Bacterial infections : 13% 2 erysipelas 2 abscess germs in cause were not identified (the pyoculture wasn’t decisive in both cases of abscess). Cutaneous infection(2)- our study-

11. Urinary infection (1): • 20 to 40%of diabetic infections : • The cytobacteriological trial was decisive only in 20 % of the patients presenting urinary signs, while it found germs in cause in 60 % of the cases for the others series* *M. OUEDRAOGO et al. – Médecine d’Afrique noire - 2000 *R GIRARD et al. – Médecine et Maladies infectieuses 2006

12. Urinary infection (2): • Germs in cause of the urinary infections were: • This corresponds to literaturedata** **H. GIN « Infection et diabète » Rev. Méd; Interne -1993. ** C. PAGNOUX Rev Méd; Interne – 1997.

13. Broncho-pulmonary infection: • Represents only 7% of the infections in our serie: • +++ non specifical germs. • No case of pulmonary tuberculosis infection, versus 36% in other series(*). M. Mohammadi et al. « Mortalité diabétique dans un service de médecine » Médecine du Maghreb – 1996.

14. Others infections : ORL’s infection : • Rare: 5 à 15% depending on the series(*) • Our serie: 10% • Otitis(5 cas)+++, sinusitis (3 cas). Genital infection • +++ 9% (4-6%)*. • Dominated by external uro-genital candidosis. H. GIN « Infection et diabète » Rev. Méd; Interne -1993. C. PAGNOUX Rev Méd; Interne – 1997.

15. CONCLUSION • The infection remains among the most frequent acute complications of the diabetes. It is specially represented by : • the urinary and cutaneous localisations found in the badly equilibrated diabetes. • These infections should be watched closely end regularely by : • Trying hard to identify the germs in cause • educating the patient and his relatives to avoid the acute metabolic failure • to assure a more rational care.