LES INFECTIONS DU MEMBRE SUP?RIEUR CHEZ LES PATIENTS DIAB?TIQUES

The upper limb infections in diabetics are not uncommon, often neglected, characterized by their severity and their rapid and sometimes unfavorable evolution. This is related to the harmful action of hyperglycemia on the function of chemotaxis, phagocytosis and bacteremia of neutrophils, which weakens the diabetic defenses against infections. The purpose of this work is to determine the characteristics clinical, Therapeutic, and progressive hand infections in diabetics. Through a cross-sectional study spread over 4 years, including diabetic patients with infectious lesions , having consulted at the emergency department of the Mohamed VI University Hospital of Marrakech or seen during the care. About half of them had a recent diabetes (≤ 5 years) and 61% had a peripheral neuropathy, a poor glycemic control (mean HbA1c : 10.9%). Average time prior to consultation was 15,6 days and mean hospitalization duration was 24 days. Originally it was due to a simple microtrauma in half of cases. The lesions ranged from single whitlow to dermo-necrotizing cellulitis, with 9 phlegmon and 7 gangrene or necrotizing fasciitis. A bacteriological sample was performed for 09 patients with Gram-Positive Cocci. Treatment was a triple antibiotic injection (according to antibiogram for the 09 patients), surgical drainage for 79;1% patients. The outcome was favorable in most of patients, but 6 amputations of fingers and one of the hand for wet gangrene; one death occured. In conclusion, the treatment of infections of the upper limb in diabetic patients should be intensive and multidisciplinary as early as possible to avoid a delay in their management and severity of lesions that can lead to sequelae or even death. All the patients were poorly followed with poorly adapted or insufficient antidiabetic treatment explaining the severity of the attacks and their rapid and unfavorable evolution.