title: Diabetes: a risk factor for catheter-associated infections.
abstract: OBJECTIVE
  The incidence of infectious complications associated with continuous regional anesthesia techniques is a matter of concern. Our objective was to determine whether patients suffering from diabetes are at an increased risk of catheter-related infectious complications.
  
  
  METHODS
  The German Network for Regional Anaesthesia database was analyzed between 2007 and 2012. After proof of plausibility, data of 36,881 patients undergoing continuous regional anesthesia were grouped in I: no diabetes (n = 32,891) and II: any diabetes (n = 3990). The analysis focused on catheter-related infections after strict definition. Differences among the groups were tested with t and χ tests. Odds ratios were calculated with logistic regression and adjusted for potential confounders.
  
  
  RESULTS
  Patients with a diagnosis of diabetes had an increased incidence of catheter-related infections (no diabetes 3.0% vs any diabetes 4.2%; P < 0.001). Among all patients, diabetes remained an independent risk factor for infections for all sites after the adjustment for potential confounders (odds ratio [OR] = 1.26; 95% confidence interval [95% CI], 1.02-1.55; P = 0.036). The risk of infection was significantly increased in peripheral catheters only in the lower limb (adjusted OR = 2.42; 95% CI, 1.05-5.57; P = 0.039). If neuraxial catheters were used, the risk was significantly increased only in lumbar epidural (adjusted OR = 2.09; 95% CI, 1.18-3.73; P = 0.012) for diabetic patients compared with nondiabetic patients.
  
  
  CONCLUSIONS
  The presence of diabetes is associated with an increased risk for catheter-related infections in lower limb and lumbar epidural. Specific care should be taken to avoid and detect infections in this population.
authors.affiliation: From the *Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, and †Institut of Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, University Medical Center, Homburg/Saar; ‡Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University, Hospital, Frankfurt; §Department of Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg; ∥Department of Anesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Solingen; **Department of Anesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hannover, Hannover; ††Department of Intensive Care Medicine, HELIOS Hospital, Bad Saarow; ‡‡Department of Anesthesiology, Intensive Care and Pain Therapy, HELIOS Hospital, Erfurt; §§Department of Anesthesioly, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm; and ∥∥Department of Anesthesiology and Operative Intensive Care Medicine, CharitéCampus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Bomberg
authors.forename: Christine
authors.initials: C
authors.lastname: Kubulus
authors.forename: Franka
authors.initials: F
authors.lastname: List
authors.forename: Noemi
authors.initials: N
authors.lastname: Albert
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schmitt
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.forename: Paul
authors.initials: P
authors.lastname: Kessler
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
authors.forename: Thomas
authors.initials: T
authors.lastname: Standl
authors.forename: André
authors.initials: A
authors.lastname: Gottschalk
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Wirtz
authors.forename: Gerald
authors.initials: G
authors.lastname: Burgard
authors.forename: Peter
authors.initials: P
authors.lastname: Geiger
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.forename: Thomas
authors.initials: T
authors.lastname: Volk
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000453:epidemiology*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors