Diabetes and acute bacterial skin and skin structure infections.

Acute bacterial skin and skin structures infections (ABSSSIs) are associated with high morbidity, costs and mortality in patients with diabetes mellitus. Their appropriate management should include several figures and a well-organized approach. This review aims to highlight the interplay between diabetes and ABSSSIs and bring out the unmet clinical needs in this area. Pathogenetic mechanisms underlying the increased risk of ABSSSIs in diabetes mellitus are multifactorial: high glucose levels play a crucial pathogenetic role in the tissue damage and delayed clinical cure. Moreover, the presence of diabetes complications (neuropathy, vasculopathy) further complicates the management of ABSSSIs in patients with diabetes. Multidrug resistance organisms should be considered in this population based on patient risk factors and local epidemiology and etiological diagnosis should be obtained whenever possible. Moreover, drug-drug interactions and drug-related adverse events (such as nephrotoxicity) should be considered in the choice of antibiotic therapy. Reducing unnecessary hospitalizations and prolonged length of hospital stay is of primary importance now, more than ever. To achieve these objectives, a better knowledge of the interplay between acute and chronic hyperglycemia, multidrug resistant etiology, and short and long-term outcome is needed. Of importance, a multidisciplinary approach is crucial to achieve full recovery of these patients.

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Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘MF received speaker honoraria for Angelini, MSD, Pfizer, and Nordic Pharma. JJM received personal fees from Astra Zeneca, Boehringer-Ingelheim, Eli Lilly, MSD, Novo Nordisk, Sanofi, Servier. JMA has received honoraria for speaking at symposia organized on behalf of Pfizer, Astellas, Merck Sharp & Dohme (MSD), Angelini, and Gilead Science and has sat on advisory boards on behalf of Pfizer, Astellas, MSD, Angelini, and Gilead Science. SDP reports grants and/or personal fees from Boehringer Ingelheim, Astra Zeneca, Novo Nordisk, Eli Lilly, GlaxoSmitheKline, MSD, Novartis Pharmaceuticals, Sanofi, Takeda. FM has participated in advisory boards and/or received speaker honoraria from Angelini, Correvio, MSD, Pfizer, Astellas, Gilead, BMS, Jansenn, ViiV, BioMerieux, Biotest, Becton-Dickinson, Nordic Pharma, Pfizer, Shionogi. All COI are outside the submitted study. All authors disclose personal fees from Ethos, during the conduct of the study.’