Incidence and risk factors for developing infection in patients presenting with uninfected diabetic foot ulcers

Abstract

ObjectiveThere is a paucity of research on patients presenting with uninfected diabetic foot ulcers (DFU) that go on to develop infection. We aimed to investigate the incidence and risk factors for developing infection in a large regional cohort of patients presenting with uninfected DFUs.MethodsWe performed a secondary analysis of data collected from a validated prospective state-wide clinical diabetic foot database in Queensland (Australia). Patients presenting for their first visit with an uninfected DFU to a Diabetic Foot Service in one of thirteen Queensland regions between January 2012 and December 2013 were included. Socio-demographic, medical history, foot disease history, DFU characteristics and treatment variables were captured at the first visit. Patients were followed until their DFU healed, or if their DFU did not heal for 12-months, to determine if they developed a foot infection in that period.ResultsOverall, 853 patients were included; mean(standard deviation) age 62.9(12.8) years, 68.0% male, 90.9% type 2 diabetes, 13.6% indigenous Australians. Foot infection developed in 342 patients for an overall incidence of 40.1%; 32.4% incidence in DFUs healed <3 months, 55.9% in DFUs healed between 3–12 months (p<0.05). Independent risk factors (Odds Ratio (95% confidence interval)) for developing infection were: DFUs healed between 3–12 months (2.3 (1.6–3.3)), deep DFUs (2.2 (1.2–3.9)), peripheral neuropathy (1.8 (1.1–2.9)), previous DFU history (1.7 (1.2–2.4)), foot deformity (1.4 (1.0–2.0)), female gender (1.5 (1.1–2.1)) and years of age (0.98 (0.97–0.99)) (all p<0.05).ConclusionsA considerable proportion of patients presenting with an uninfected DFU will develop an infection prior to healing. To prevent infection clinicians treating patients with uninfected DFUs should be particularly vigilant with those presenting with deep DFUs, previous DFU history, peripheral neuropathy, foot deformity, younger age, female gender and DFUs that have not healed by 3 months after presentation.

Effect on total microbial load and community composition with two vs six‐week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers

“…The primary goals in managing infected ulcers are to eliminate the source of infection and then obtain skin coverage. The latter is a key marker of success and resolution of any infective process . If skin coverage is not achieved, then risk of re‐infection is increased.…”

“…The latter is a key marker of success and resolution of any infective process. 30 If skin coverage is not achieved, then risk of re-infection is increased. Cadexomer Iodine may disrupt a pathogenic biofilm through reducing the total microbial load and by affecting the community composition and diversity.…”

Risk factors for mortality in patients with diabetic foot infections: a prospective cohort study

“…In Australia, diabetic foot ulcers are the second most common complication of diabetes, with up to 85% of all amputations associated with diabetes . While foot ulceration alone is a major cause of hospital admission from diabetes, a recent Queensland study found that 40.1% of diabetic ulcers were complicated by infection within 1 year of first presentation …”

“…3,4 While foot ulceration alone is a major cause of hospital admission from diabetes, 5 a recent Queensland study found that 40.1% of diabetic ulcers were complicated by infection within 1 year of first presentation. 6 In 2015, the Diabetic Foot Infections in Northern Australia (DEFINE) study highlighted a disproportionately high burden of diabetic foot infections (DFI) in the Top End of the Northern Territory of Australia, particularly within the Aboriginal and Torres Strait Islander population (herein respectfully referred to as indigenous people). Patients with DFI had a high incidence of minor and major amputations (30.5 and 9.6%, respectively) and prolonged hospital admissions (median 29 days).…”

Multicenter Study of the Burden of Multidrug-Resistant Bacteria in the Etiology of Infected Diabetic Foot Ulcers

“…4 Between 25-60% of diabetic patients with background foot ulcer will develop IDFU which remains a major reason for non-traumatic amputation of the lower limbs. 5 Wide varieties of organisms, including anaerobic bacteria, have been implicated in the etiology of IDFU depending on severity of infection and time from onset to presentation at the healthcare facility. Advanced IDFUs with features of sepsis at admission usually harbor anaerobic pathogens.…”