Diabetic’s infections (100 cases) C. RAGGABI; H. IRAQI; F. AJDI; MH GHARBI; A. CHRAIBI. Endocrinology & Diabetology Department CHU Avicenne ; Rabat – Morocco.

INTRODUCTION: Diabete mellitus is a complex chronic disease PANDEMY!!! Particularities of the diabetic’s infection: It’s frequency Subjects to infections Metabolic failure’s risk diagnosis and therapeutics' difficulties The aim of our study is: To determine: clinical and therapeutical aspects acute infection’s and their evolution in our patients Evaluate the quality of treatment in our Moroccan context.

MATERIAL & METHODS(1) retro-prospective study 100 diabetic patients hospitalized in our department during two years from January 2005 to December Hospitalisation reason: - Unstable Glycaemia - ketosis failure. The parameters we studied:  anthropometric Criteria  The localisation of infection  Glycaemia balance  Metabolic repercussions  Treatment  Evolution

MATERIAL & METHODS(2) The female ratio is predominant; with sex. ratio = 3 Age rate = 44,05 years +/-15.6.

RESULTS (1) Infectious episode was found in 75% of diabetics All patients (100%) were hyperglycaemic during the episode of the infection : Fasting glucose rate= 2.52 g/l +/ HbA1c average = 9.4% +/

RESULTS (2) Infection was found in:

RESULTS (3) The localisation of infections cutaneous 42,66% Urinary 30,66% ORL 10,35% Genital 9,33% Broncho pulmon. 7%

RESULTS (4) Treatment and evolution Antibiotics Prescription: Favourable evolution for % of our patients Estimated on the clinical & biological criteria and the regression of the metabolic trouble. One case of recurrence of the cutaneous abscess one week after being discharged. After antibiogramUnknown antibiogram 2.67%97.33%

DISCUSSION Cutaneous infection (1) The diabetic infections prevalence according to international series ( 20 – 35% ) : under estimated prevalence because (*): There isn’t enough motivation for consultation Treated in dermatology department (*)S. BENAMOR « Manifestations cutanéo-muqueuses du Diabète » EMC – M. MOHAMMADI (1996) 117 cases S. AMAL (2004) 105 cases M. OUEDRAOGO (2000) 85 cases H. GIN (1993) 208 cases Our SERIE (2006) 100 cases 17.8%20%29.4%30%42%

Cutaneous infection(2) - our study- +++ mycosic infections (87 %): Intertrigo Onychomycosis Mycosis the mycological taking of nails was made only in one case. Bacterial infections : 13% 2 erysipelas 2 abscess germs in cause were not identified (the pyoculture wasn’t decisive in both cases of abscess).

Urinary infection (1): 20 to 40% of diabetic infections : The cytobacteriological trial was decisive only in 20 % of the patients presenting urinary signs, while it found germs in cause in 60 % of the cases for the others series* *M. OUEDRAOGO et al. – Médecine d’Afrique noire *R GIRARD et al. – Médecine et Maladies infectieuses 2006 M. MOHAMMADI (1996) 117 cases R. GIRARD (2006) 153 cases M. OUEDRAOGO (2000) 85 cases H. GIN (1993) 208 cases Our SERIE (2006) 100 cases 10.58%22.4%17.65%35%30.66%

Urinary infection (2): Germs in cause of the urinary infections were : This corresponds to literature data ** **H. GIN « Infection et diabète » Rev. Méd; Interne ** C. PAGNOUX Rev Méd; Interne – Our studyC. Pagnoux (1997)H. Gin (1993) E. coli33%28%30% Klebsiella12%20%24% Pseudomonas4%12% 16% Candida1.8%3%_ Not identified49.2%37%30%

Broncho-pulmonary infection: Represents only 7% of the infections in our serie: +++ non specifical germs. No case of pulmonary tuberculosis infection, versus 36% in other series(*). M. Mohammadi et al. « Mortalité diabétique dans un service de médecine » Médecine du Maghreb – M. OUEDRAOGO (2000) 85 cases M. MOHAMMADI (1996) 117 cases Our SERIE (2006) 100 cases 47.06%63.1%7%

Others infections : ORL’s infection : Rare: 5 à 15% depending on the series(*) Our serie: 10% Otitis (5 cas)+++, sinusitis (3 cas). Genital infection +++ 9% (4-6%)*. Dominated by external uro-genital candidosis. H. GIN « Infection et diabète » Rev. Méd; Interne C. PAGNOUX Rev Méd; Interne – 1997.

CONCLUSION  The infection remains among the most frequent acute complications of the diabetes. It is specially represented by :  the urinary and cutaneous localisations found in the badly equilibrated diabetes.  These infections should be watched closely end regularely by :  Trying hard to identify the germs in cause  educating the patient and his relatives to avoid the acute metabolic failure  to assure a more rational care.