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Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions

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Abstract

Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.

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Data availability

The datasets generated during this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (Grant No. 82370903) and the Joint Medical Research Key Programs of Chongqing Science and Technology Bureau and Health Commission Foundation (No. 2023ZDXM009) awarded to Dr. Wuquan Deng. This study is also partially supported by the National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases (1R01124789-01A1) and the National Science Foundation (NSF) Center to Stream Healthcare in Place (#C2SHiP) CNS (2052578) awarded to Prof. Armstrong DG.

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Authors and Affiliations

  1. The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China

    Yan Chen & Xiaoqiu Xiao

  2. Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China

    Yan Chen, Puguang Xie, Chenzhen Du, Shunli Rui, Zixiao Duan & Wuquan Deng

  3. Department of Emergency, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China

    Bin Liu

  4. Geriatric Medical Center, Bazhong City Central Hospital, Bazhong, 636600, China

    Huan Chen

  5. Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China

    Hao Mei

  6. Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA

    David G. Armstrong

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Contributions

Bin Liu, Literature search, data extraction. Puguang Xie, data collation and analysis, Shunli Rui, draft writing. Huan Chen: Data analysis, Chenzhen Du, draft review and modification；Yan Chen ,Wuquan Deng and Xiaoqiu Xiao: Research ideas, method design, paper review. Yan Chen, wrote the main manuscript text. Zixiao Duan , revise manuscript. Hao Mei,Guidance on statistical methods. All authors reviewed the manuscript.David G. Armstrong,Guide project design.

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Correspondence to Wuquan Deng or Xiaoqiu Xiao.

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All procedures performed in this study involving human participants were approved by the Ethics Committee of the Chongqing University Central Hospital University and performed in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chen, Y., Liu, B., Chen, H. et al. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. Arch Dermatol Res 316, 144 (2024). https://doi.org/10.1007/s00403-024-02856-x

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