[Epidemiological characteristics of adult inpatients with diabetes-related chronic non-healing wounds in Hainan province]

Abstract

Objective: To analyze the epidemiological characteristics of adult inpatients with diabetes-related chronic non-healing wounds in Hainan province. Methods: This study was a retrospective cohort study. From July 2019 to July 2024, 1 372 adult inpatients with diabetes-related chronic non-healing wounds and conformed to the inclusion criteria were admitted to three hospitals in Hainan province, including 951 cases in the First Affiliated Hospital of Hainan Medical University, 287 cases in the Second Affiliated Hospital of Hainan Medical University, and 134 cases in Hainan Sino-German Orthopedic Hospital. The clinical data of patients were collected, including age, gender, occupation, disease duration and type of diabetes mellitus, underlying comorbidity, formation cause, type, location, and number of wounds, pathogenic microorganism culture result of wound secretion specimens on admission, treatment modality and outcome at discharge, and hospitalization duration and hospitalization costs of patients with different types of wounds. Results: The patients were 18-96 years in age, with 892 patients aged ≥60 years. There were 889 males and 483 females, with 838 agricultural workers. The duration of diabetes mellitus was 10 (5,18) years, and 98.91% (1 357/1 372) of the patients had type 2 diabetes mellitus. Patients with diabetes mellitus were often combined with hypertension (678 cases), arterial disease (300 cases), and stroke (220 cases). The primary cause of wound formation was infection (930 cases). The predominant type of wounds was diabetic foot ulcer (809 cases), followed by other wounds (232 cases), pressure ulcers (187 cases), and traumatic ulcers (144 cases). The wounds were primarily located on feet (809 wounds) and lower legs (474 wounds) with single wound (997 cases). The pathogenic microorganism culture results of wound secretion specimens from 540 patients were positive, with a total of 606 strains of pathogenic microorganism detected, predominantly Gram-negative bacteria (324 strains). The main pathogenic microorganisms were Staphylococcus aureus (125 strains), Pseudomonas aeruginosa (71 strains), and Escherichia coli (71 strains). Fungal detection rate was high of 6.11% (37/606). The primarily wound treatment modalities included simple debridement (396 cases) and debridement combined with vacuum sealing drainage (444 cases). At discharge, the wounds in 84.62% (1 161/1 372) of the patients showed improvement, 11.30% (155/1 372) of the patients achieved wound healing, and 3.28% (45/1 372) of the patients experienced wound exacerbation; the other 0.80% (11/1 372) of the patients died. Patients with diabetic foot ulcer exhibited significantly longer hospitalization duration (18 (10, 29) d) and higher hospitalization costs (3.9 (2.1, 6.0) ten thousand yuan) compared with patients with pressure ulcer (14 (7, 21) d and 2.8 (1.5, 4.2) ten thousand yuan), traumatic ulcer (12 (6, 18) d and 2.3 (1.2, 3.5) ten thousand yuan), and other wounds (16 (8, 25) d and 3.1 (1.8, 5.0) ten thousand yuan), P<0.05. Conclusions: The adult inpatients with diabetes-related chronic non-healing wounds in Hainan province are predominantly elderly male agricultural workers with underlying comorbidities. The detected predominant pathogenic microorganisms in wounds are Gram-negative bacteria, and fungal detection rate is high. Diabetic foot ulcer poses greater treatment burden, and patients with diabetic foot ulcers had significantly longer hospitalization duration and higher hospitalization costs compared with those of other wounds.