Relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait.

OBJECTIVE: To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. SUBJECTS AND METHODS: Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA(1c) values, nature of specimens and species of the isolated pathogens. HbA(1c) <7% was used as the breaking point for diabetic control and occurrence of postoperative complications. Primary outcomes with infectious complications, including urinary tract infection, surgical site infection (SSI), lower respiratory tract infection and sepsis with different isolated pathogens were identified at least 48 h postoperatively. RESULTS: Of 318 diabetic patients who underwent surgical operations, 90 (28.3%) developed postoperative complications; HbA(1c) <7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.51 (95% confidence interval, 1.20-2.89). Regarding types of complications, urinary tract infectious complications were significantly higher among those patients with HbA(1c) > or =7% (p < 0.0001), while other complications (SSI, lower respiratory tract infection and sepsis) showed nonsignificant differences (p > 0.05). CONCLUSIONS: Our study confirmed a close association between preoperative glucose control indicated by HbA(1c) levels <7% and a decreased risk of postoperative infectious complications. Ideally, preoperative blood sugar should be controlled prior to elective surgery. Prophylaxis by antibiotics with preoperative patient preparation, proficient surgical technique and postoperative wound care is recommended for uncontrolled diabetics subjected to surgery.

Surveillance of antibacterial resistance in Staphylococcus aureus isolated in Kuwaiti hospitals.

OBJECTIVE: To investigate the prevalence of antibiotic resistance among Staphylococcus aureus isolated in Kuwaiti hospitals. MATERIALS AND METHODS: S. aureus were isolated and identified following standard microbiological methods. Antibacterial susceptibility test was performed by disk diffusion and the measurement of minimum inhibitory concentration with E-test strips. RESULTS: A total of 1,846 S. aureus isolates were analyzed from 13 hospitals between 1 March and 30 October 2005. They were isolated from 1,765 (95.6%) inpatients and 81 (4.4%) outpatients. Methicillin resistance was detected in 588 (32.0%) of the isolates. The methicillin-resistant S. aureus (MRSA) consisted of 461 (78%) multiresistant and 127 (22%) nonmultiresistant isolates. The nonmultiresistant MRSA consisted of epidemic MRSA-15 and community-associated MRSA. The community-associated MRSA was detected in all hospitals with MRSA, indicating its establishment in Kuwaiti hospitals. The proportion of isolates resistant to gentamicin, kanamycin, erythromycin, tetracycline, ciprofloxacin, fusidic acid and trimethoprim was higher among MRSA than methicillin-susceptible S. aureus (MSSA) isolates. Twenty-four and 22% of MRSA and MSSA isolates, respectively, expressed reduced susceptibility to vancomycin (minimum inhibitory concentration = 3-4 mg/l). CONCLUSION: The study revealed the presence of methicillin resistance in 32% of S. aureus isolated in Kuwaiti hospitals and revealed an increase in the number of MRSA and MSSA with reduced susceptibility to vancomycin.