Risk Factors for Foot Infections in Individuals With Diabetes

Abstract

OBJECTIVE -To prospectively determine risk factors for foot infection in a cohort of people with diabetes.RESEARCH DESIGN AND METHODS -We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.RESULTS -During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture-proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3-102.2; P Ͻ 0.001) and the risk of amputation was 154.5 times greater (58.5-468.5; P Ͻ 0.001). Foot wounds preceded all but one infection. Significant (P Ͻ 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration Ͼ30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).CONCLUSIONS -Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

“…23 In diabetics, local infections, with plantar ulcers, edema, and hyperemia, are known high-risk factors for amputations. 8,24 However, the present study observed that only sepsis was related to major amputations, irrespective of the presence of local infection. In these cases, the importance of taking a treatment decision immediately to prevent progression to septic shock and death cannot be overstated.…”

“…Diabetic patients with neuropathy and/or ischemia are more susceptible to ulceration and infection, which generally results in amputation. 8 Traumatisms and malignant tumors are responsible for, respectively, 10.6% and 5.8% of lower limb amputations. 2 Despite the increase in the number of revascularization interventions, some studies indicate that the prevalence of amputations has remained unaltered because of the increase in cases of atherosclerosis and diabetes mellitus and aging of the population.…”

Primarily non-surgical management of osteomyelitis of the foot in diabetes

“…Infection of the bone is a common complication of foot ulceration in patients with diabetes and presents a considerable therapeutic challenge [1]. Despite the existence of published guidelines [2,3], approaches to the management of osteomyelitis of the foot in diabetic patients may vary quite widely, especially as few robust data are available to inform clinical practice [4].…”

Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections

“…16 It is possible that this fact is related to the wide range of factors that act synergistically together in establishment and proliferation of lesions of the diabetic foot. 5 Bacterial resistance was observed for several different drugs, but it was clindamycin, which is widely utilized in empirical regimes for treatment of the diabetic foot, to which bacteria were most often resistant (59%). It should be pointed out that, in this study, anaerobic germs, which tend to be treated using clindamycin, were not investigated.…”

“…3 Efforts should be concentrated on achieving early diagnosis of infection of diabetic ulcers, because infection is associated with up to 56 times greater risk of hospital admissions and up to 155 times the risk of amputation. 4,5 In addition to the suffering inflicted on patients, hospital treatment of the diabetic foot tends to be of high cost to the healthcare system. Even after hospital discharge, these patients generally require permanent care and, sometimes, repeated admissions to treat the same problem.…”