Hepatitis C Virus Infection in the Patients with Type 2 Diabetes Mellitus

The association of hepatitis C virus (HCV) infection with diabetes mellitus (DM) is a well documented topic. However, it has been debated whether HCV infection is the additional risk factor for the development of DM or it is an associated disease. To determine the prevalence of HCV infection and associated risk factors in diabetic patients, we investigated anti-HCV antibody in the 207 patients with DM (mean age: 58.9 ± 9.3, range 38-85) and 254 control subjects (mean age: 54.0 ± 9.7, range 40-81) by ELISA method, and risk factors for HCV infection in diabetic patients. Statistical analysis was performed by chi-square test, t-test and logistic regression analysis. Anti-HCV was found positive in 16 (7.7%) of diabetic cases and 5 (2.0%) of the control subjects. According to this result, a higher seroprevalence of HCV infection was observed in patients with type 2 DM (p= 0.003). We did not detect any difference between anti-HCV positive and negative patients with respect to age, sex, duration of diabetes, hospital admission, mode of therapy and known risk factors for HCV infection (p> 0.05) whereas mean ALT levels was higher in anti-HCV positive patients (p= 0.05). The results of this study suggest that HCV infection in the diabetic patients seems a trigger factor rather than to be an associated disease

The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

We aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 +/- 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection (p = .043) and vancomycin treatment (p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency (p = .004), hospital readmission (p = .009), C-reactive protein > 130 mg/dL (p = .007), and receiving carbapenems (p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials