Systemic Infection in Diabetic Foot Ulcers

NewsBot · Nov 15, 2016

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Invasive Systemic Infection Following Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival
Shey-Ying Chen, John M. Giurini, and Adolf W. Karchmer
Clin Infect Dis. (2016)

Background Diabetic foot ulcers (DFU) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infections related to DFUs (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality are not defined.

Methods We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFU during a 9-year period. We defined the index ulcer as that present on the first (index) DFU admission to our hospital. We defined DFU-ISI as a non-foot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors and mortality associated with DFU-ISIs.

Results After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISI, 64% were bacteremia, 13 % deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicillin-resistant Staphylococcus aureus (MRSA) caused 57 %. Patients with initial DFU cultures yielding MRSA and protracted open ulcers experienced high 24-month cumulative probability of DFU-ISI (31%) and all-cause mortality (13%). On Cox regression modeling complicated ulcer healing (hazard ratio (HR), 3.812; 95% confidence interval (CI), 2.434-5.971) and initial DFU culture yielding MRSA (HR 2.030; 95% CI 1.452-2.838) predicted DFU-ISIs and DFU-ISIs were associated with increased mortality (HR, 1.987; 95% CI, 1.106-3.568).

Conclusions DFU-ISIs are important late complications of DFUs. Prevention of DFU-ISIs should be studied prospectively. Meanwhile, clinicians should aggressively incorporate treatment to accelerate ulcer healing and address MRSA into the care of diabetic patients with foot ulcers.
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Admin2 · Nov 15, 2016

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Infected diabetic foot ulcers decision making

NewsBot · Sep 29, 2019

Diabetic Foot Infection Presenting Systemic Inflammatory Response Syndrome: A Unique Disorder of Systemic Reaction from Infection of the Most Distal Body.
Lin CW et al
J Clin Med. 2019 Sep 25;8(10)

Diabetic foot infection (DFI) is a major complication of diabetic foot that lead to nontraumatic lower-extremity amputation (LEA). Such distal infection of the body having systemic inflammatory response syndrome (SIRS) is rarely reported. Consecutive patients treated for limb-threatening DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 to 2017. Clinical factors, laboratory data, perfusion, extent, depth, infection and sensation (PEDIS) wound score in 519 subjects with grade 3 DFI and 203 presenting SIRS (28.1%) were compared. Major LEA and in-hospital mortality were defined as poor prognosis. Patients presenting SIRS had poor prognosis compared with those with grade 3 DFI (14.3% versus 6.6% for major LEA and 6.4% versus 3.5% for in-hospital mortality). Age, wound size, and HbA1c were independent risk factors favoring SIRS presentation. Perfusion grade 3 (odds ratio 3.37, p = 0.044) and history of major adverse cardiac events (OR 2.41, p = 0.036) were the independent factors for poor prognosis in treating patients with DFI presenting SIRS. SIRS when presented in patients with DFI is not only limb- but life-threatening as well. Clinicians should be aware of the clinical factors that are prone to develop and those affecting the prognosis in treating patients with limb-threatening foot infections.
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