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.
