Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Cervantes-García, Estrella; Salazar-Schettino, Paz Marı́a

doi:10.1080/2000625x.2017.1367210

Cited by 22 publications

(25 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that age was not a significant risk factor for amputation in patients with DFI. However, male sex and smoking, which were indicated as risk factors for amputation in diabetes‐related foot ulceration, were also found to be risk factors for amputation in DFI in our meta‐analysis. This may be because male sex and smoking have traditionally been the main factors in the development of PAD caused by atherosclerotic plaque formation.…”

Section: Discussionmentioning

confidence: 61%

“…These infection markers can be elevated in the presence of osteomyelitis, which has been shown to be a strong predictor of amputation, so these markers might indirectly predict amputation. From another perspective, the increase in acute‐phase reactants might indicate an inflammatory process triggered by an impaired immune response, deterioration of the peripheral circulation, or a high blood glucose level . Inflammation and infection may also contribute to the development of PAD, thereby allowing these inflammatory markers to predict amputation in patients with DFI.…”

Section: Discussionmentioning

confidence: 99%

“…From another perspective, the increase in acute-phase reactants might indicate an inflammatory process triggered by an impaired immune response, deterioration of the peripheral circulation, or a high blood glucose level. 12 Inflammation and infection may also contribute to the development of PAD, 12 thereby allowing these inflammatory markers to predict amputation in patients with DFI.…”

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

108

View full text Add to dashboard Cite

Background Knowledge of risk factors is crucial to develop management and treatment protocols for the prevention of lower extremity amputation for patients with diabetic foot infections (DFIs). Methods We searched the research literature for studies reporting risk factors for lower extremity amputation in patients with DFI. The main outcome variables included both minor and major amputations. This study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42018118543). Results A total of 2471 potential articles from the database search met the inclusion criteria. After reviewing the titles, abstracts, and full texts, remaining 25 articles were included in the final analysis. We identified 6132 patients with DFI in the 25 included articles. Of these, 1873 patients who underwent amputation were investigated. Male gender (odds ratio [OR]: 1.31), smoking (OR: 1.38), history of amputation (OR: 1.47), history of osteomyelitis (OR: 1.94), peripheral arterial disease (OR: 2.35), retinopathy (OR: 1.32), International Working Group on the Diabetic Foot (IWGDF) grades 3 and 4 (OR: 1.7 and 2.5), Wagner grades 4 and 5 (OR: 4.3 and 6.4), gangrene/necrosis (OR: 9.9), osteomyelitis (OR: 4.5), neuroischaemic DFI (OR: 3.06), severe infection (OR: 3.12), length of hospitalization (standardized mean difference [SMD]: 0.7), leukocytosis (OR: 1.76), mean erythrocyte sedimentation rate (ESR) (SMD: 0.5), mean C‐reactive protein (CRP) (SMD: 0.8), tissue culture positivity (OR: 1.61), and isolation of Gram‐negative bacteria from tissue culture (OR: 1.5) were found as predictors of amputation in DFI. Conclusions The present study highlighted some differences in diabetic foot ulcers and DFIs in terms of risk factors for lower extremity amputation. These data provide detailed information about risk factors for amputations among patients with DFI, thus contributing to the creation of new classification systems for assessment of high‐risk patients.

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Meta-analysis Of the Clinical Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Meta‐analysis of risk factors for amputation in diabetic foot infections

Şen

Demırdal

Emir

2019

Diabetes Metabolism Res

108

View full text Add to dashboard Cite

show abstract

“…The presence of macro vascular disease and associated infection of the ulcer increases the chances of amputation of lower limb. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The depth of the ulcer is an important factor which decides the outcome of the diabetic foot ulcer.…”

mentioning

confidence: 99%

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Malepati

Vakamudi

Kandati³

et al. 2017

Int Surg J

View full text Add to dashboard Cite

Background: Diabetes is considered as one of the most important and rapidly evolving non-communicable disease which requires top priority around the world. 10-25% of diabetics develop foot infections [DFI’s] during the course of their disease period ranging from simple calluses to major Osteomyelitis. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The present study was done to assess the microbial flora according to Wagner’s classification for diabetic foot disease. To isolate, identify the aerobic bacterial pathogens and their drug sensitivity pattern with reference to ESBL productionMethods: A prospective study was conducted at a tertiary care hospital by department of general surgery among Diabetics presenting with diabetic foot infections. All the enrolled cases were classified based on Wagner’s classification and socio demographic data was noted. Specimens from the ulcer were collected and processed for isolation, identification of pathogens based on standard CLSI guidelines. The antibiotic sensitivity of the isolates was done and ESBL production was demonstrated by standard guidelines.Results: 346 cases were enrolled in study and grade-3 Wagner’s ulcers were predominant. Males were predominant, 46-55 years age group was common with mean age of 55.3±1.4 years. Peripheral arterial disease was more common than peripheral neuropathy and both were found significantly associated with development of ulcers. Methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa were most common isolates. MRSA exhibited maximum sensitivity to vancomycin, clindamycin and linezolid. Gram negative isolates exhibited maximum sensitivity to meropenems, piperacillin-tazobactam. The prevalence of ESBL producers in the study was 16.24%.Conclusions: DFI are a serious concern in uncontrolled diabetics and require proper management. Outcome of the infection depends upon the grading of the ulcer as per Wagner’s classification and also the nature of the infection either polymicrobial or with a single organism. Our study highlights and suggests that prospective multicentre studies are required to assess the appropriate antibiotic regimen in diabetic foot ulcers and proper management of antibiotics must be implemented to decrease the incidence and development of multi drug resistant organisms.

show abstract

“…It was also found that the most affected areas by DFUs were the forefoot (48%) and the plantar region (55%) of the foot. Most patients had advanced stages of DFUs, where 93% of the lesions were grades III-V, according to the Wagner classification [11]. In 2016, a report revealed evidence that hemoglobin A1c (HbA1c) <5.8% works as a beneficial factor [12].…”

Section: Introductionmentioning

confidence: 99%

Diabetic Foot Ulcers: Current Advances in Antimicrobial Therapies and Emerging Treatments

et al. 2019

View full text Add to dashboard Cite

Diabetic foot ulcers (DFUs) are very important diabetes-related lesions that can lead to serious physical consequences like amputations of limbs and equally severe social, psychological, and economic outcomes. It is reported that up to 25% of patients with diabetes develop a DFU in their lifetime, and more than half of them become infected. Therefore, it is essential to manage infection and ulcer recovery to prevent negatives outcomes. The available information plays a significant role in keeping both physicians and patients aware of the emerging therapies against DFUs. The purpose of this review is to compile the currently available approaches in the managing and treatment of DFUs, including molecular and regenerative medicine, antimicrobial and energy-based therapies, and the use of plant extracts, antimicrobial peptides, growth factors, ozone, devices, and nano-medicine, to offer an overview of the assessment of this condition.2 of 32 history [2]. DFUs are one of the most severe complications of diabetes, and more than half of those ulcers become infected. Every single one of these infected lesions has the potential to get worse and compromise the integrity of the lower limbs. To avoid amputations and improve the patient's quality of life, it is very important to implement a strict program for the prevention and treatment of ulcers, as well as proper management of infections [3]. Thus, it is critical to keep diabetes patients aware of new therapies and treatments and their availability in the healthcare system. The treatment of DFUs requires a multidisciplinary approach with proper medical tools, skills, and knowledge. This starts from patient education, with the application of new classifications to guide the treatment to prevent amputations. New diagnosis methods should become available, such as the 16S ribosomal DNA sequence in bacteria, to provide a better understanding of the microbiota in DFUs. It is reported that DFU has a polymicrobial nature, and, according to its geographical location, certain marked differences, wound characteristics, antibiograms according to local epidemiology, individualized antimicrobial guided therapy, regular debridement, regular assessment of wounds, and change of dressings. The latter characteristics are also aided by new biological and molecular therapies that were proven to improve infection control, the regulation of the local inflammatory profile, and improved quality of the cicatrizing process. In the next sections, this review presents an approach for the diagnosis and treatment of DFUs, focusing on the current advances in antimicrobial therapies, such as dressings,

show abstract

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Cited by 22 publications

References 42 publications

Meta‐analysis of risk factors for amputation in diabetic foot infections

Meta‐analysis of risk factors for amputation in diabetic foot infections

Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study

Diabetic Foot Ulcers: Current Advances in Antimicrobial Therapies and Emerging Treatments

Contact Info

Product

Resources

About