Frequent hospital admissions for bacterial infections among aboriginal people with diabetes in central Australia

OBJECTIVE: To determine hospital-based morbidity and mortality from bacterial infections among Aboriginal people with diabetes in central Australia. DESIGN: Examination of medical records on diabetic inpatients between January 1984 and December 1986. SETTING: Alice Springs Hospital in central Australia, covering an Aboriginal population of about 12,500 people. PATIENTS: Subjects admitted with a bacterial infection (n = 165) were selected from the database of all Aboriginal people known to have diabetes in the region (n = 374; all had non-insulin dependent diabetes). MAIN OUTCOME MEASURES: Number of admissions, type and site of infections, causative organisms, duration of hospital stay and cause of death. RESULTS: The 281 admissions for infections accounted for 4.6% of adult Aboriginal admissions to hospital. Thirteen patients died. Eleven patients required amputation of a digit or limb. In 1986, 13/200 patients admitted with diabetes had bacteraemia compared with 14/1885 patients who did not have diabetes. One patient had Fournier's gangrene, one had malignant otitis externa, one community acquired Acinetobacter pneumonia, one pneumonia with Succinivibrio spp. found in blood cultures, and one meningitis and transverse myelopathy with Streptococcus milleri found in blood cultures. CONCLUSIONS: The frequency, type and severity of infections in the relatively young patients result in high personal costs to the community and financial costs to the health care system. Standard preventive measures must be implemented to control severe bacterial infections among subjects with diabetes in this socially and economically marginalised population group.