Severe diabetic foot infections without systemic inflammatory response syndrome: Prospective validation of a new category

Abstract

We aimed to validate the prognostic value of subclassifying moderate diabetic foot infections into two categories: moderate and moderate/severe. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections.Moderate infections were subclassified after applying a previously published score.Variables associated with prognosis were: need for any amputation, major amputation, need for hospitalisation, length of hospitalisation, length of antibiotic therapy, reinfection rate and infection-related mortality. Infections were moderate in 111 cases (55.5%) and severe in 89 (44.5%). Osteomyelitis (OM) was diagnosed in 114 cases (57%), 73 moderate (36.5%) and 41 severe (20.5%). Patients with severe OM had a higher rate of amputations, major amputations, hospitalisations and need for antibiotic therapy, and a longer duration of antibiotics when compared with moderate OM. After applying the score, moderate infections were subclassified into 73 moderate cases (65.7%) and 38 moderate/severe cases (34.3%). Moderate/severe had a higher rate of amputations, major amputations, hospitalisations and need for antibiotics than moderate ones. No differences regarding prognosis were found between moderate/severe and severe infections with systemic inflammatory response syndrome. Moderate/severe diabetic foot infections, which could also be known as severe infections without systemic inflammatory response syndrome, should be recognised as a new subgroup. We propose to merge severe diabetic foot infections with and without systemic inflammatory response syndrome into a unique category due to its prognostic value. Furthermore, OM should be added to both moderate and severe new categories of diabetic foot infections.

Outpatient Foot-Sparing Surgery Is Safe in Selected Patients with Diabetic Foot Infections

“…Both issues reflect the severity of the patients who were hospitalized. 21 Patients with low serum albumin and high inflammatory markers can be better managed in a hospital setting.…”

“…The presence of necrosis was also more frequent in admitted patients versus outpatients. Both issues reflect the severity of the patients who were hospitalized 21 . Patients with low serum albumin and high inflammatory markers can be better managed in a hospital setting.…”