title: Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess.
abstract: BACKGROUND
  Among diabetics, complicated skin infections may involve gram-negative pathogens; however, the microbiology of cellulitis and cutaneous abscess is not well established.
  
  
  OBJECTIVE
  To compare the microbiology and prescribing patterns between diabetics and nondiabetics hospitalized for cellulitis or abscess.
  
  
  METHODS
  Secondary analysis of 2 published retrospective cohorts.
  
  
  METHODS
  Adults hospitalized for cellulitis or abscess, excluding infected ulcers or deep tissue infections, at 7 academic and community facilities.
  
  
  METHODS
  Microbiological findings and antibiotic use were compared among diabetics and nondiabetics. Multivariable logistic regression was performed to identify factors associated with exposure to broad gram-negative therapy, defined as receipt of at least 2 calendar days of β-lactamase inhibitors, second- to fifth-generation cephalosporins, fluoroquinolones, carbapenems, tigecycline, aminoglycosides, or colistin.
  
  
  RESULTS
  Of 770 total patients with cellulitis or abscess, 167 (22%) had diabetes mellitus. Among the 38% of cases with a positive culture, an aerobic gram-positive organism was isolated in 90% of diabetics and 92% of nondiabetics (P = 0.59); aerobic gram-negative organisms were isolated in 7% and 12%, respectively (P = 0.28). Overall, diabetics were more likely than nondiabetics to be exposed to broad gram-negative therapy (54% vs 44% of cases, P = 0.02). By logistic regression, diabetes mellitus was independently associated with exposure to broad gram-negative therapy (odds ratio: 1.66, 95% confidence interval: 1.15-2.40).
  
  
  CONCLUSIONS
  In cases of cellulitis or abscess associated with a positive culture, gram-negative pathogens were not more common among diabetics compared with nondiabetics. However, diabetics were overall more likely to be exposed to broad gram-negative therapy suggesting this prescribing practice may not be not warranted.
authors.affiliation: Department of Medicine, Denver Health, Denver, Colorado; Division of Infectious Diseases, Denver Health, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.forename: S
authors.initials: S
authors.lastname: Jason Moore
authors.forename: Carla C
authors.initials: CC
authors.lastname: Saveli
authors.forename: Sean W
authors.initials: SW
authors.lastname: Pawlowski
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Perlman
authors.forename: Bruce D
authors.initials: BD
authors.lastname: McCollister
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents