title: Short-term glycemic control is effective in reducing surgical site infection in diabetic rats.
abstract: BACKGROUND
  Patients and animals with diabetes exhibit enhanced vulnerability to bacterial surgical infections. Despite multiple retrospective studies demonstrating the benefits associated with glycemic control in reducing bacterial infection after cardiac surgery, there are fewer guidelines on the use of glycemic control for noncardiac surgeries. In the current study, we investigated whether long-term (begun 2 weeks before surgery) or immediate (just before surgery) glycemic controls, continued postoperatively, can reduce surgical site infection in type 1 diabetic-induced rats.
  
  
  METHODS
  Rats were injected with streptozotocin to induce type 1 diabetes. Four groups of animals underwent surgery and thigh muscle Staphylococcus aureus bacteria challenge (1 × 10 colony forming units) at the time of surgery. Group 1 diabetic rats received insulin treatment just before surgery and continued until the end of study (short-term glycemic control group). Group 2 diabetic rats received insulin treatment 2 weeks before surgery and continued until the end of study (long-term glycemic control). Group 3 diabetic rats received no insulin treatment (no glycemic control group). Group 4 nondiabetic rats served as a healthy control group. Rats were euthanized at 3 or 6 days after surgery. Blood glucose and muscle bacterial burden were measured at 3 or 6 days after surgery.
  
  
  RESULTS
  Glycemic control was achieved in both long- and short-term insulin-treated diabetic rats. Compared with untreated diabetic rats, the bacterial burden in muscle was significantly lower in both groups of glycemic controlled diabetic rats at 3 (all P < 0.003) and 6 (all P < 0.0001) days after surgery.
  
  
  CONCLUSIONS
  A short-term glycemic control regimen, initiated just before surgery and bacterial exposure, was as effective in reducing surgical site infection as a long-term glycemic control in type 1 diabetic rats. These data suggest that immediately implementing glycemic control in type 1 diabetic surgical patients before undergoing noncardiac surgery may decrease the risk of infection.
authors.affiliation: From the *Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois; †Department of Biochemistry, Rush University Medical Center, Chicago, Illinois; and ‡Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kroin
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.forename: Jinyuan
authors.initials: J
authors.lastname: Li
authors.forename: Mario
authors.initials: M
authors.lastname: Moric
authors.forename: Hee-Jeong
authors.initials: HJ
authors.lastname: Im
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Tuman
authors.forename: Sasha H
authors.initials: SH
authors.lastname: Shafikhani
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003921:Diabetes Mellitus, Experimental / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D004334:Drug Administration Schedule; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D018482:Muscle, Skeletal / Q000382:microbiology; D017207:Rats, Sprague-Dawley; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013311:Streptozocin; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D013311:Streptozocin