Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use

Dunkel, Nathalie; Belaieff, Wilson; Assal, Mathieu; Corni, Valentina; Karaca, Şaziye; Lacraz, Alain; Uçkay, İlker

doi:10.1007/s00776-012-0245-5

Cited by 23 publications

(20 citation statements)

References 23 publications

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“…Third, we only assessed for infectious recurrences. We did not include non‐infected ulcers, postoperative haematomas or wound dehiscence, which, although resource‐consuming, are not usually treated with antibiotic therapy . Fourth, we decided against analysing our data based on either the specific antibiotic agents used or the role of specific pathogens (besides P. aeruginosa ).…”

Section: Discussionmentioning

confidence: 99%

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Gariani

Lebowitz

Dach

et al. 2018

Diabetes Obesity Metabolism

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Section: Discussionmentioning

confidence: 99%

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Gariani

Lebowitz

Dach

et al. 2018

Diabetes Obesity Metabolism

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“…Firstly, prevention against surgical site infection following major amputation, not specifically in DFI. Studies unanimously advocate the use of prophylactic antibiotics generally for 0‐48 hours and up to 5 days . Secondly, residual infection, with authors supporting culture of intraoperative bone samples from residual stumps, rather than from the removed bone .…”

Section: Discussionmentioning

confidence: 99%

“…However, due to high rates of poor outcomes of these amputation wounds, it is a common practice to prolong antibiotic therapy unnecessarily, potentially resulting in drug‐related adverse effects and costs, and possible development of antibiotic resistance . We previously published a retrospective study on the continuation of antibiotic prophylaxis in leg amputations and found no benefit in doing so . In this study, we used our clinical pathway to question the continuation of post‐amputation antibiotics.…”

Section: Introductionmentioning

confidence: 99%

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Rossel

Lebowitz

Gariani

et al. 2019

Endocrino Diabet & Metabol

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Summary Objective The appropriate duration of antibiotic therapy for diabetic foot infections (DFI) after surgical amputations in toto is debated. There are discrepancies worldwide. Methods Using a clinical pathway for adult DFI patients (retrospective cohort analysis), we conducted a cluster‐controlled Cox regression analysis. Minimum follow‐up was 2 months. Results We followed 482 amputated DFI episodes for a median of 2.1 years after the index episode. The DFIs predominately affected the forefoot (n = 433; 90%). We diagnosed osteomyelitis in 239 cases (239/482; 50%). In total, 47 cases (10%) were complicated by bacteremia, 86 (18%) by abscesses and 139 (29%) presented with cellulitis. Surgical amputation involved the toes (n = 155), midfoot (280) and hindfoot (47). Overall, 178 cases (37%) required revascularization. After amputation, the median duration of antibiotic administration was 7 days (interquartile range, 1‐16 days). In 109 cases (25%), antibiotics were discontinued immediately after surgery. Overall, clinical failure occurred in 90 DFIs (17%), due to the same pathogens in only 38 cases. In multivariate analysis, neither duration of total postsurgical antibiotic administration (HR 1.0, 95% CI 0.99‐1.01) nor immediate postoperative discontinuation altered failure rate (HR 0.9, 0.5‐1.5). Conclusion According to our clinical pathway, we found no benefit in continuing postsurgical antibiotic administration in routine amputation for DFI. In the absence of residual infection (ie, resection at clear margins), antibiotics should be discontinued.

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“…[14][15][16] To our knowledge, there has not been an attempt to thoroughly summarize the existing evidence of the association between diabetes and incident infections and quantify the association across a spectrum of infectious diseases. Therefore, we conducted a systematic review and meta-analysis to provide a comprehensive summary of the current state of the evidence surrounding the relationship between diabetes and incident infections.…”

Section: What Are the New Findings?mentioning

confidence: 99%

The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies

Abu-Ashour

Twells

Valcour

et al. 2017

BMJ Open Diab Res Care

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Objective To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis. Research design and methods Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and nonspecified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I 2 statistic and explored using subgroup analyses. Results A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and nonspecified (OR 3.53, 95% CI 2.62 to 4.75). Conclusion Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections. INTRODUCTIONThe International Diabetes Federation estimates that there were almost 400 million people living with diabetes throughout the world in 2014. The prevalence of diabetes is expected to increase to more than 590 million people by the year 2035.1 Well-known complications of diabetes include both microvascular (retinopathy, neuropathy, nephropathy) and macrovascular (coronary heart disease, cerebrovascular disease, and peripheral vascular disease) 2 ; however, there are numerous lesser known complications including effects on immunity.3-5 Immune system dysfunction in people with diabetes may be mediated through impaired migration, phagocytosis, intracellular killing, and chemotaxis. [4][5][6][7][8] Indeed, several studies have suggested that people with diabetes are at an increased risk of infection-related mortality 9 10 ; however, not all studies support such an association. 12Furthermore, patients with diabetes tend to be hospitalized for infections more frequently than those without.

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Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use

Cited by 23 publications

References 23 publications

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies

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