Endocrine Abstracts

Introduction: The uncontrolled diabetics are led to develop severe infections like severe forms of acute bacterial dermo-hypodermitis. The aim of our study was to clarify the epidemiological, clinical and therapeutic characteristics of BDH in diabetic patients.

Patients and methods: A prospective, descriptive and analytical study was conducted in the Diabetology, Endocrinology and Metabolism Department, Ibn Rochd University Hospital of Casablanca, from January 2016 to December 2017, including all diabetic patients with BDH. Necrotizing fasciitis are excluded from the study. Statistical analysis was univariate for all the variables using SPSS version 22.0.0.

Result: Were included 134 diabetics, 57% had a T2D, their middle-aged was 53, and average HbA1c was 9.8%. 37% of patients were hypertensive, 32% dyslipidemic, 18% with ischemic cardiomyopathy, 37.5% had diabetic retinopathy, 61% diabetic nephropathy, 46% peripheral neuropathy and 23% autonomic neuropathy. Risk factors for BDH were a lower extremity edema in 38%, obesity in 30%, age greater than 65 years in 23%, inadequate hygiene in 22%, obliterating arteriopathy of lower limbs in 20%, active smoking in 16% and previous history of BDH in 11%. Average duration of consultation was 6 days. Localization was the leg in 67% of cases and the foot in 47%. Entry point was a fungal interdigital in 31% of cases, a perforating ulcer of the foot in 29%, and anarterial ulceration in 10%. BDH was accompanied by local signs of severity in 28% of cases, complicated in 14%. Fever was present in 43% of patients, with general signs in 37%. Infection was moderate involving the member in 34%, severe involving the lives of patients in 23%. Third-generation cephalosporins were used in 43% of cases, a monotherapy in 43% and dual therapy in 28%, initially, intravenously in all patients. Evolution was good in the majority of cases, 4 patients had presented a necrotizing fasciitis and 6 patients had presented a necrotizing bacterial dermo-hypodermitis without necrotizing fasciitis.

Conclusions: The diabetic is a subject at high risk of developing severe forms of BDH. Perforating ulcer of the foot and arterial ulceration are frequently the entry points.