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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 2006. 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. Type 2 Type 1 Gestationnel 1 Type 2 56% Type 1 42,60% Gestationnel 1,40% RESULTS (1) infe ction proportion in our diabe tic patie nts no Infection in fectio n 75% 25% 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 +/- 1.32 HbA1c average = 9.4% +/- 2.07. RESULTS (2) Infection was found in: 49% 50% Examen clinique systématique décompensation cétosique RESULTS (3) The localisation of infections cutaneous 42,66% Urinary 30,66% ORL Genital 10,35% 9,33% Broncho pulmon . 7% RESULTS (4) Treatment and evolution Antibiotics Prescription: After antibiogram Unknown antibiogram 2.67% 97.33% Favourable evolution for 98.60 % 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. DISCUSSION Cutaneous infection (1) The diabetic infections prevalence according to international series ( 20 – 35% ) : 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% under estimated prevalence because (*): There isn’t enough motivation for consultation Treated in dermatology department (*)S. BENAMOR « Manifestations cutanéo-muqueuses du Diabète » EMC – 2002. Cutaneous infection(2) +++ mycosic infections (87 %): Intertrigo Onychomycosis Mycosis the mycological taking of nails was made only in one case. - our studyBacterial 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 : 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% 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 - 2000 *R GIRARD et al. – Médecine et Maladies infectieuses 2006 Urinary infection (2): Germs in cause of the urinary infections were: Our study C. Pagnoux (1997) H. Gin (1993) E. coli 33% 28% 30% Klebsiella 12% 20% 24% 4% 12% 16% Candida 1.8% 3% _ Not identified 49.2% 37% 30% Pseudomonas This corresponds to literature data ** **H. GIN « Infection et diabète » Rev. Méd; Interne -1993. ** C. PAGNOUX Rev Méd; Interne – 1997. Broncho-pulmonary infection: Represents only 7% of the infections in our serie: M. OUEDRAOGO (2000) 85 cases M. MOHAMMADI (1996) 117 cases Our SERIE (2006) 100 cases 47.06% 63.1% 7% +++ 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 – 1996. 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 -1993. 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.