Advances in Infections and Wound Healing for the Diabetic Foot

Παπάνας, Νικόλαος; Mani, Raj

doi:10.1177/1534734613490507

Cited by 17 publications

(13 citation statements)

References 39 publications

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“…Despite the improvements in diagnosis and management of infected diabetic and the technology advances, foot ulcers remain a significant challenge to specialists involved in diabetes care. 17 The bacteriology found is this lesions is in the majority cases polymicrobial; the most frequent organisms isolated reported in the literature are S. aureus, Group B Streptococcus, Enterococcus, anaerobic bacteria and enteric gramnegative organisms. 18,19 The use of empiric oral antimicrobial regimens are unlikely to provide antimicrobial activity against many of the pathogens isolated in these infections.…”

Section: Discussionmentioning

confidence: 92%

“…The complete treatment of moderate to severe infections as in the patients included in this study requires not only antimicrobial therapy, but also timely surgical drainage and revascularization in some cases. Despite the improvements in diagnosis and management of infected diabetic and the technology advances, foot ulcers remain a significant challenge to specialists involved in diabetes care . The bacteriology found is this lesions is in the majority cases polymicrobial; the most frequent organisms isolated reported in the literature are S. aureus , Group B Streptococcus , Enterococcus , anaerobic bacteria and enteric gram‐negative organisms .…”

Section: Discussionmentioning

confidence: 99%

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Impact of the bacteriology of diabetic foot ulcers in limb loss

Hinojosa

Boyer-Duck

Anaya‐Ayala

et al. 2016

Wound Repair Regeneration

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Infections in feet of patients with diabetes mellitus is common, complex and costly. The aim of this study to investigate the isolated microorganisms in infected diabetic foot ulcers, and the impact of these infectious agents in limb loss in a tertiary medical center in Mexico City. We conducted a retrospective review in diabetic patients with infected foot ulcers from 1997 to 2014. Diabetic foot was defined according to the World Health Organization (WHO), the bacteriology of wound cultures and the impact of microorganisms in limb loss (major amputation) was studied. Patient's demographics, comorbidities, wound characteristics, and other factors associated in clinical outcomes were determined. A total of 165 subjects with soft tissue infections and/or osteomyelitis and positive cultures were included. One hundred and five (64%) were male, with a mean age of 60 year old +/- 15. One hundred fifty-nine (96%) had Type 2 diabetes mellitus, 68 (41%) history of peripheral arterial disease (PAD) and 97 (59%) patients had osteomyelitis. In 89 patients (54%), cultures were polymicrobial and one single organism was isolated in 76 cultures (46%). During the follow up, 96 (58%) patients preserved their limbs and 69 (42%) required major amputation (above or below knee). Sixty percent of patients that suffered from limb loss had polymicrobial culture (p = 0.13). Growth of Escherichia coli and Enterococcus faecium (p = 0.03) and E. coli and Morganella morgagnii (p = 0.03) was associated to limb loss. Among monomicrobial cultures, infections associated with Proteous mirabilis had higher rate of progression to limb loss (p = 0.03). PAD was associated to limb loss (p = 0.001). Management of diabetic foot requires a multimodality approach. In this study, in patients that received appropriate antibiotic therapy and optimal surgical management, we observed that history of PAD, polymicrobial and isolated P. mirabilis infections were variables associated with higher rate of limb loss.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Impact of the bacteriology of diabetic foot ulcers in limb loss

Hinojosa

Boyer-Duck

Anaya‐Ayala

et al. 2016

Wound Repair Regeneration

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“…Despite the improvements in diagnosis and management, DFI remains a significant challenge [8]. In this large cohort study conducted Turkey, we studied the predictors of limb loss among inpatients and outpatients patients with DFI, described the bacteriologic findings and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey

Saltoğlu

Yemişen

Ergönül

et al. 2015

Clinical Microbiology and Infection

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We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.

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“…Diabetic foot ulcers remain a serious medical problem, which is extremely difficult to heal and exhibits a high recurrence rate [ 1 ]. Thus, it is continuously receiving increased scientific attention, in an effort to improve outcomes [ 2 – 4 ]. There is ongoing progress in peripheral arterial disease [ 1 ], neuropathy [ 1 , 5 ], off-loading [ 1 , 2 ], infection [ 1 , 2 ], and wound healing [ 1 , 2 ].…”

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confidence: 99%