Outcomes of Chopart Amputation in a Tertiary Referral Diabetic Foot Clinic: Data From a Consecutive Series of 83 Hospitalized Patients

Faglia, Ezio; Clerici, Giacomo; Frykberg, Robert G.; Caminiti, Maurizio; Curci, Vincenzo; Cetta, Francesco; Prisco, Vincenzo; Greco, Rosaria; Prisco, Marco di; Morabito, Alberto

doi:10.1053/j.jfas.2015.09.004

Cited by 24 publications

(37 citation statements)

References 27 publications

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“…One hundred eighty‐two full‐text articles were assessed for eligibility, and 133 (65 reviews, eight studies of duplicated population, and 60 studies with data that cannot be extracted) of them were removed since they did not meet our selection criteria. Finally, 49 articles were included in our meta‐analysis after full‐text review …”

Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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Recurrence rates of diabetic foot ulcers vary widely in the published literature. The aim of this systematic review is to estimate recurrence rates of diabetic foot ulcers. We did a PubMed search and performed a review of reference lists for studies reporting recurrence of diabetic foot ulcers. The weighted relative risk (RR) and corresponding 95% confidence interval (CI) for recurrence was estimated. Forty‐nine studies reporting recurrence of diabetic foot ulcers were included. A pooled estimate for recurrence rate was 22.1% per person‐year (py) (95% CI, 19.0‐25.2%). Recurrence rate was 24.9% per py in Europe (95% CI, 20.0%‐29.7%), 17.8% per py in North America (95% CI, 12.7%‐22.9%), 16.9% per py in Africa (95% CI, 4.7%‐29.0%), and 17.0% per py in Asia (95% CI, 11.1%‐23.0%). Turkey had the highest recurrence rate of 44.4% per py (95% CI, 24.9%‐63.9%), and Bangladesh had the lowest of 4.3% per py (95% CI, 2.3%‐6.3%). Recurrence rates of diabetic foot ulcers before 2002, between 2002 and 2008, and after 2008 were 22.2% per py (95% CI, 17.6%‐26.8%), 21.9% per py (95% CI, 17.0%‐26.8%), and 21.8% per py (95% CI, 16.3%‐27.2%), respectively. Recurrence rates of diabetic foot ulcers are high. Recurrence rates vary widely in different regions and have decreased recently. More attention towards recurrence of diabetic foot ulcers is urgently required.

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Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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“…Increased mortality with age has been previously reported among patients with diabetic foot ulceration – after toe amputation for a diabetic foot – and in patients with DFI in the context of chronic kidney disease . Increased age‐related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly . In our study, only two (0.5%) patients had major amputation as their initial procedure, and only 11 (2.7%) had a previous major amputation, limiting any conclusion that may have been drawn regarding outcomes after previous or initial major amputation level.…”

Section: Discussionmentioning

confidence: 61%

“…14,20,21 Increased age-related comorbidities may play a role, as may the recognised poorer outcomes after amputation in the elderly. 21,22 In our study, only two (0.5%) patients had major amputation as their initial procedure, and only 11 (2.7%) had a previous major amputation, limiting any conclusion that may have been drawn regarding outcomes after previous or initial major amputation level.…”

Section: Discussionmentioning

confidence: 69%

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

Lynar

Robinson

Boutlis

et al. 2019

Internal Medicine Journal

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Background An increasing prevalence of diabetes mellitus has led to a high risk of diabetic foot infections (DFI) and associated morbidity. However, little is known about the relationship between DFI and mortality. Aim To investigate the risk of mortality and associated factors in patients with DFI in an Australian context. Methods A prospective cohort study of inpatients with DFI between May 2012 and October 2016 was done at Royal Darwin Hospital, a tertiary referral hospital for the Top End of the Northern Territory. Primary outcome was 1‐year mortality with Cox regression analysis undertaken to assess risk factors for mortality. Results Four hundred and thirteen consecutive adult diabetic patients with 737 admissions were referred to the High‐Risk Foot Service for DFI. Cumulative risk of mortality at 1 year was 8.9% (95% confidence interval (CI) 6.4–12.2). On univariable analysis, mortality was associated with older age (hazard ratio (HR) per year increase 1.08, 95% CI 1.06–1.11, P = 0.001), haemodialysis (HR 3.64, 1.74–7.62, P < 0.001), isolation of Pseudomonas aeruginosa (HR 2.32, 1.05–5.12, P = 0.04) and ischaemic heart disease (HR 2.05, 1.04–4.07, P = 0.04), while indigenous status (HR 0.48, 0.25–0.95, P = 0.04) and HbA1c > 7% (HR 0.45, 0.20–0.99, P < 0.05) were protective. After adjusting for confounders, independent risk factors for mortality were haemodialysis (adjusted HR 5.76, 95% CI 2.28–14.59, P < 0.001) and older age (adjusted HR 1.09, 1.06–1.13, P < 0.001). Patients on haemodialysis had a cumulative risk of mortality of 24.5% (95% CI 14.0–40.8) at 1 year. Conclusion There is a high risk of mortality associated with DFI, substantially increased in patients undergoing haemodialysis, highlighting the importance of early and dedicated interventions targeted at this high‐risk group.

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“…This occurs because biofilms have increased cellular density [18], demonstrate drug efflux properties [19] and has modulated levels of b-1,3-glucan with overexpression of exopolysaccharide glycocalyx modulation that sequester the drug molecules and impedes access to bacteria [20,21]. These combine to require longduration treatment (generally >6 weeks) with combinations of antimicrobials, resection of tissues, amputation, and the emergence of drug resistance [7,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, musculoskeletal wounds are characterised by biofilm formation, and reduced bacterial susceptibility to treatment [5,6]. As a result, these wounds require extendedduration treatment (generally >4-6 weeks) with the combinations of antimicrobials, resection of tissues and amputation in some cases [7].…”

Section: Introductionmentioning

confidence: 99%

Elastin-like polypeptide incorporated thermally sensitive liposome improve antibiotic therapy against musculoskeletal bacterial pathogens

Nigatu

Ashar

Sethuraman

et al. 2018

International Journal of Hyperthermia

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Musculoskeletal infections caused by bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa in children and adults can lead to adverse outcomes including a need for extensive surgical debridement and limb amputation. To enable targeted antimicrobial release in infected tissues, the objective of this study was to design and investigate novel elastin-like polypeptide (ELP)-based thermally sensitive liposomes in vitro. ELP biopolymers can change their phase behaviour at higher temperatures. We hypothesised that ELP-TSL will improve therapeutic efficacy by releasing antimicrobial payloads locally at higher temperatures (!39 C). ELP-TSL library were formulated by varying cholesterol and phospholipid composition by the thin film and extrusion method. A broad-spectrum antimicrobial (Ciprofloxacin or Cipro) was encapsulated inside the liposomes by the ammonium sulphate gradient method. Cipro release from ELP-TSLs was assessed in physiological buffers containing $25% serum by fluorescence spectroscopy, and efficacy against Staphylococcus aureus and Pseudomonas aeruginosa was assessed by disc diffusion and planktonic assay. Active loading of Cipro achieved an encapsulation efficiency of 40-70% in the ELP-TSL depending upon composition. ELP-TSL Cipro release was near complete at !39 C; however, the release rates could be delayed by cholesterol. Triggered release of Cipro from ELP-TSL at $42 C induced significant killing of S. aureus and P. aeruginosa compared to 37 C. Our in vitro data suggest that ELP-TSL may potentially improve bacterial wound therapy in patients.ARTICLE HISTORY

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Outcomes of Chopart Amputation in a Tertiary Referral Diabetic Foot Clinic: Data From a Consecutive Series of 83 Hospitalized Patients

Cited by 24 publications

References 27 publications

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

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

Elastin-like polypeptide incorporated thermally sensitive liposome improve antibiotic therapy against musculoskeletal bacterial pathogens

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