Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study

Abstract

AimsTo determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer.MethodsThis multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence.ResultsIn the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).ConclusionsClinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.

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

“…A recent study by Ndosi et al . in the UK found an annual mortality of 15.1% in 299 patients with infected diabetic foot ulcers; however, the majority were enrolled from an outpatient setting . The higher mortality in their cohort contrasts with the present study, raising the possibility that hospitalisation with access to a specialist service might reduce risk, although notably it was in a different setting and a different healthcare system.…”

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

“…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 …”

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

“…Diabetic foot infections (DFIs) are associated with substantial morbidities, requiring frequent health care provider visits, daily wound care, antimicrobial therapy, surgical procedures, and high health care costs . Of particular importance, DFIs remain the most frequent diabetic complication requiring hospitalization and the most common precipitating event leading to lower extremity amputation . Outcomes in patients presenting with an infected diabetic foot ulcer (IDFU) are poor: in one large prospective study, at the end of 1 year, the ulcer had healed in only 46% (and it later recurred in 10% of these), while 15% had died and 17% required a lower extremity amputation .…”