Diabetic Foot Syndrome (DFS) commonly occurs with infected ulceration and is associated with a high rate of amputation and excessive mortality. Antibiotic therapy increases the risk of Clostridium difficile infection (CDI). The mean CDI rate in European hospitals is 7.0 cases (country range 0.7-28.7) per 10 000 patient-bed days (PBD). The risk of hospital-acquired CDI (HA-CDI) among patients with diabetes mellitus (DM) and DFS may be much higher than in the general hospitalized population. The aim of the study is to define the incidence of HA-CDI in patients with DM and DFS. We performed a retrospective analysis using 2018 data from a tertiary diabetes care hospital which provides medical care mostly to patients with diabetes, including those admitted from the emergency department. We included patients with CDI confirmed by positive test result for toxins A/B. In 2018, CDI occurred in 22 cases, including 9 in patients with DFS. Overall, the CDI incidence rate was 21.6 cases per 10 000 PBD. The rate was much higher among patients with DFS than among patients department-wide (IRR: 3.73, 95% CI: 1.59-8.71). Prior to testing for toxins A/B, antibiotics were used in all DM patients with DFS who developed HA-CDI (9/9) and in 83.8% (109/130) DFS cases not complicated by CDI. Patients with DFS and CDI were characterized by lower mean BMI (28.3±0.4 vs. 30.3±0.6 kg/m2, p=0.01) than patients with DFS and without CDI. Between these two groups, no statistically significant differences were found in sex (male: 96/130 vs. 6/9, p=0.70), median age at hospitalization (65.0 (57.0-70.0) vs. 62.0 (52.0-67.0) yrs., p=0.30), HbA1c (68.3 (42.1-80.3) vs. 60.7 (49.7-78.1) mmol/mol, p=0.93) and eGFR (78.0 (62.0-93.0) vs. 84.5 (54.0-97.0) ml/min/1,73m2, p=0.91). Our results showed that DM patients with DFS had a higher risk of CDI than patients department-wide.


J. Hohendorff: None. M. Serafin: None. P.W. Witek: None. S. Borys: None. B. Katra: None. M. Malecki: None.

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