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Aktuelle Dermatologie 2020; 46(03): 94-101
DOI: 10.1055/a-0881-6683
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Einfluss des Diabetes mellitus Typ II auf Inzidenz, Mikrobiologie, Verlauf und Prognose des Erysipels[*]

Influence of Diabetes mellitus Type II on Incidence, Microbiology, Clinical Course and Prognosis of Erysipelas
L. Eickenscheidt
1   Klinik für Hautkrankheiten und Allergologie, Helios Vogtland-Klinikum Plauen GmbH
,
J.-M. Pönnighaus
1   Klinik für Hautkrankheiten und Allergologie, Helios Vogtland-Klinikum Plauen GmbH
2   Abteilung für Berufsdermatologie, BG-Klinik Falkenstein
,
L. Kowalzick
1   Klinik für Hautkrankheiten und Allergologie, Helios Vogtland-Klinikum Plauen GmbH
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Publikationsverlauf

Publikationsdatum:
08. Mai 2019 (online)

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Zusammenfassung

Hintergrund und Fragestellung Die Behandlung des Erysipels, einer klassischen Infektionskrankheit in der Dermatologie, wird durch die Auswirkungen des demografischen Wandels und multimorbidere Patienten zunehmend kompliziert. Es gibt kaum miteinander vergleichbare Daten zu Zusammenhängen zwischen Diabetes mellitus und Erysipelen. Anhand der Patienten des Helios Vogtland-Klinikums Plauen wird die Rolle des Diabetes mellitus als Risikofaktor für die Inzidenz und den Verlauf von Erysipelen untersucht.

Patienten/Methodik In einer retrospektiven Untersuchung wurden 592 Patienten, die in den Jahren 2007 – 2017 stationär behandelt wurden, ausgewertet. Die Einschlusskriterien waren: Alter über 18 Jahre, Antibiose > 5 Tage und Plausibilität der Befunde bei stationärer Aufnahme sowie eine vorliegende Diabetes-Diagnostik bzw. -Behandlung. Mikrobiologische Befunde waren kein Kriterium.

Ergebnisse Durchschnittlich 42 % der stationär behandelten Patienten mit Erysipel waren auch an einem Diabetes mellitus Typ II erkrankt oder hatten einen okkulten Diabetes, während der Anteil von Diabetes-Patienten im Krankenhaus insgesamt nur konstant ca. 20 % betrug (p < 0,001). Ein Wechsel des primär eingesetzten i. v. -Antbiotikums war bei Erysipel-Patienten mit einem Diabetes mellitus Typ II oder einem okkulten Diabetes aufgrund eines Therapieversagens in 46 % der Fälle erforderlich, bei Patienten ohne Diabetes mellitus in 33 % (OR: 1,7, p = 0,005). Eine Sepsis entwickelten 11 % bzw. 4 % (OR: 2,8, p = 0,002) und stationär behandelte Rezidive 19 % bzw. 10 % (OR: 2,0, p = 0,007) der jeweiligen Kollektive mit und ohne gleichzeitigem Diabetes. Bei Patienten mit Diabetes mellitus Typ II zeigte sich ein signifikant besseres Ansprechen auf die Kombination Ceftriaxon/Ciprofloxacin als auf die Monotherapie mit Penicillin G (OR 4,1 [95 % CI 2,1 – 7,6]; p < 0,005).

Schlussfolgerungen Der Diabetes mellitus Typ II stellt bei stationär behandelten Patienten einen Risikofaktor für Inzidenz, Verlauf und Prognose der Erysipel-Erkrankung dar. Stationär behandelte Patienten mit Erysipel sollten ein Diabetes-Screening erhalten. Patienten mit klinischem Erysipel und Diabetes mellitus Typ II profitieren von der leitlinienempfohlenen Standard-Antibiose möglicherweise weitaus weniger als bisher angenommen.

Abstract

Background and Purpose The treatment of erysipelas, a classic infectious disease in dermatology, is becoming increasingly complicated by the effects of demographic change and more multimorbidity in patients. Based on the current study situation, there are hardly any comparable data on erysipelas and diabetes mellitus. The role of diabetes mellitus as a risk factor for the incidence of erysipelas was investigated on the basis of patients at the Helios Vogtland-Klinikum Plauen.

Methods In a retrospective study, the clinical data on the influence of diabetes mellitus on the course of erysipelas were collected, classified and statistically evaluated from 592 patients who were hospitalized with erysipelas between 2007 and 2017.

Results On average, 42 % of inpatients with erysipelas suffered from diabetes mellitus type II or had an occult diabetes, while among all (about 27 000 per year) inpatients the percentage with diabetes mellitus was only around 20 % (p < 0.001). A change of the initially used i. v. – antibiotic due to therapy failure became necessary in 46 % of the erysipelas cases with diabetes mellitus type II or occult diabetes compared to 33 % in those patients without concomitant diabetes (OR: 1.7, p = 0.005). A sepsis developed in 11 % resp. 4 % (OR: 2.8, p = 0.002) and recurrences in 43 % resp. 30 % (OR: 2.0, p = 0.007) in the corresponding groups with or without concomitant diabetes. In patients with concomitat diabetes mellitus type II there was a better therapeutic response with the combined antibiotic treatment with ceftriaxon/ciprofloxacin compared to treatment with penicillin G (OR 4.1 [95 % CI 2.1 – 7.6]; p < 0.005) only.

Conclusions Hospitalized patients with erysipelas should receive a diabetes screening. Patients with clinical erysipelas and type II diabetes mellitus may benefit far less from the guideline-recommended standard antibiotic treatment than previously assumed. Local influencing factors and late effects of diabetes mellitus type II (vasculopathy and neuropathy) may be the reasons for the increased incidence of erysipelas. In addition, an altered immune status and elevated blood sugar levels play a role that has not yet been conclusively clarified.

* Diese Arbeit beinhaltet Teile der Promotionsschrift von L. Eickenscheidt.


 

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