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.

Characterisation of Clostridium difficile strains by polymerase chain reaction with toxin A- and B-specific primers.

A total of 218 Clostridium difficile strains was examined for production of toxin A by ELISA, production of toxin B by a cytotoxin assay and the presence of toxin A and B gene-associated sequences by the polymerase chain reaction (PCR). After saturation amplification with toxin B-specific primers, the characteristic amplification product (591 bp) was detected in all 184 toxigenic strains examined. PCR with toxin A-specific primers gave positive results with all but one of the toxigenic strains. By contrast, PCR with toxin A- and toxin B-specific primers yielded negative results with all 34 non-toxigenic strains tested. This suggests that PCR detection of either the toxin A or B gene is a good indication of toxin production. PCR did not require DNA extraction or hybridisation and was convenient, sensitive and rapid. Toxigenic C. difficile could be detected in mixed cultures, suggesting a role for PCR in the identification of toxigenic C. difficile in primary culture.