title: Associations of diabetes mellitus with orthopaedic infections.
abstract: BACKGROUND
  Clinical experience suggests that a high proportion of orthopaedic infections occur in persons with diabetes.
  
  
  METHODS
  We reviewed several databases of adult patients hospitalized for orthopaedic infections at Geneva University Hospitals from 2004 to 2014 and retrieved 2740 episodes of infection.
  
  
  RESULTS
  Overall, diabetes was noted in the medical record for 659 (24%) of these cases. The patients with, compared with those without, diabetes had more than five times more foot infections (274/659 [42%] vs 155/2081 [7%]; p < 0.01) and a significantly higher serum C-reactive protein level at admission (median 96 vs 70 mg/L; p < 0.01). Diabetic patients were older (median 67 vs 52 years; p < 0.01), more often male (471 [71%] vs 1398 [67%]; p = 0.04), and had more frequent polymicrobial infections (219 [37%] vs 353 [19%]; p < 0.01), including more gram-negative non-fermenting rods (90 [15%] vs 168 [9%]; p < 0.01). Excluding foot infections from these analyses did not change the statistically significant differences. Diabetes was present in 17% of all infected orthopaedic patients without foot involvement. In Geneva canton, the overall prevalence of diabetes is estimated at 5.1%, while we have found that the prevalence is 13% in our hospitalized adults.
  
  
  CONCLUSIONS
  Diabetes is present in 24% of all adult patients hospitalized for surgery for an orthopaedic infection, a prevalence that is several times higher than for the general population and twice as high as that for the population of hospitalized patients. Compared with non-diabetics, patients with diabetes have significantly more infections that are polymicrobial, including gram-negative non-fermenting rods.
authors.affiliation: a From the Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Mayahi
authors.affiliation: a From the Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Anais
authors.initials: A
authors.lastname: Cian
authors.affiliation: a From the Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.|b Service of Infectious Diseases, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kressmann
authors.affiliation: c Service of Diabetology and Endocrinology, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Benedicte
authors.initials: B
authors.lastname: de Kalbermatten
authors.affiliation: d Coding Office, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Rohner
authors.affiliation: c Service of Diabetology and Endocrinology, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Egloff
authors.affiliation: c Service of Diabetology and Endocrinology, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Jafaar
authors.initials: J
authors.lastname: Jafaar
authors.affiliation: c Service of Diabetology and Endocrinology, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Malacarne
authors.affiliation: a From the Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Hermes H
authors.initials: HH
authors.lastname: Miozzari
authors.affiliation: a From the Orthopedic Surgery Service, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.|b Service of Infectious Diseases, Geneva University Hospitals & Faculty of Medicine, University of Geneva , Geneva , Switzerland.
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000150:complications / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis*; D060085:Coinfection / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Diabetes mellitus; association; epidemiology; infection; orthopaedic