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Chen Y, Liu B, Chen H, Xie P, Du C, Rui S, Mei H, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. Arch Dermatol Res 2024; 316:144. [PMID: 38695894 DOI: 10.1007/s00403-024-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/08/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024]
Abstract
Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Bin Liu
- Department of Emergency, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Huan Chen
- Geriatric Medical Center, Bazhong City Central Hospital, Bazhong, 636600, China
| | - Puguang Xie
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Shunli Rui
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Hao Mei
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China
| | - Zixiao Duan
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China.
| | - Xiaoqiu Xiao
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Chen Y, Liu B, Huan C, Xie P, Du C, Rui S, Hao M, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. RESEARCH SQUARE 2024:rs.3.rs-3831828. [PMID: 38260272 PMCID: PMC10802731 DOI: 10.21203/rs.3.rs-3831828/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Purpose Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. Patients and Methods A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Results Both mixed bacteria (31.2% vs. 16.6%, p=0.014) and fungi (7.5% vs. 0.8%, p=0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p=0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p=0.762) and disability (6.3% vs. 12.2%, p=0.138) were not significantly differentbetween the two regions. Conclusion Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- the First Affiliated Hospital of Chongqing Medical University
| | - Bin Liu
- Chongqing University Central Hospital
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- the First Affiliated Hospital of Chongqing Medical University
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Alabdali LAS, Winkens B, Dinant GJ, van Alfen N, Ottenheijm RPG. Shoulder muscle changes in patients with type 2 diabetes mellitus who have a painful shoulder: a quantitative muscle ultrasound study. BMC Musculoskelet Disord 2022; 23:674. [PMID: 35836153 PMCID: PMC9281102 DOI: 10.1186/s12891-022-05627-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/06/2022] [Indexed: 11/12/2022] Open
Abstract
Background It is assumed that in patients with diabetic neuropathy, muscle denervation can result in shoulder disorders. Muscle denervation will lead to changes in muscle architecture, which can be assessed by quantitative muscle ultrasound (QMUS). The aim was to investigate whether increased muscle echogenicity, as a sign of neuropathy, is more often present in patients with shoulder pain who have type 2 diabetes mellitus (T2DM) than in those without. Methods Sixty-six patients with T2DM and 23 patients without diabetes mellitus (DM) having shoulder pain were included. Quantitative muscle ultrasound images were obtained bilaterally from the biceps brachii, deltoid, and supra- and infraspinatus muscles. The mean echogenicity (muscle ultrasound grey value) was transformed into z-scores and compared to reference values obtained from 50 healthy participants. Associations between muscle echogenicity and clinical variables were explored. Results In painful shoulders of both patients with T2DM and patients without DM, mean echogenicity z-scores of all muscles were significantly increased compared to healthy controls. No significant differences in echogenicity between patients with T2DM and those without DM were found. In patients with T2DM, a distal symmetric polyneuropathy was significantly associated with increased echogenicity of all muscles except the infraspinatus muscle. Conclusions These findings indicate that patients with painful shoulders, irrespective of having T2DM, seem to have abnormal shoulder muscles. Future studies are needed to elucidate whether neuropathy or other conditions lead to these muscle changes. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05627-9.
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Affiliation(s)
- Login Ahmed S Alabdali
- Dept. of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. .,Ministry of Education, Riyadh, Kingdom of Saudi Arabia.
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Geert-Jan Dinant
- Dept. of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nens van Alfen
- Dept. of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ramon P G Ottenheijm
- Dept. of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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