Major Amputation Profoundly Increases Mortality in Patients With Diabetic Foot Infection

Abstract

Introduction: An acute diabetic foot infection (DFI) is a serious condition and a leading cause of hospitalization and major amputation in patients with diabetes. Aim of this study was to evaluate the long term survival and risk factors for death and amputation after the DFI requiring hospital treatment.Materials and Methods: A retrospective study included all adult patients hospitalized for DFI treatments during 2010–2014. Overall survival (OS) and amputation free survival (AFS) (without major amputation) was calculated. We performed a Cox regression analysis of several clinical parameters to evaluate the effects of clinical parameters on overall and amputation-free survival.Results: Total of 324 patients with mean age of 66.8 (SD 12.8) years were included. The one- and five-year OS after DFI 81.2% (95%CI 77.5–84.9%) and 49.7% (95%CI 44.8–54.6%), respectively. Major amputation, wound ischemia, older age, and a low glomerular filtration rate reduced the OS after DFI. After a major amputation, the one- and five-year OS was 41.7% (95%CI 13.9–69.5) and 8.3% (95%CI 0.0–24.0%), respectively. Wound ischemia, older age, and elevated C-reactive protein reduced AFS. In contrast, hypertensive medication use was identified as a protective factor.Conclusion: Mortality after a DFI remains high and is significantly increased after a major amputation. Findings highlight the importance of early wound and ischemia management for DFI prevention.

The association between bacteria and outcome and the influence of sampling method, in people with a diabetic foot infection

“…Although infection increases the risk of amputation and amputation increases the risk of mortality, [12][13][14][15] we did not find an increased mortality risk in participants with profile 2 infections. Mortality depends on a combination of factors, and type of causative bacteria of DFI, is one of these factors.…”

“…In severe infections (including osteomyelitis), grade 4 of the International Working Group on the Diabetic Foot (IWGDF) diabetic foot infection classification, 77 to 90% of patients will undergo amputation [9][10][11]. Five-year mortality after (major) amputation is as high as 90% [12][13][14][15]. Insight in the association between different bacterial species and outcome is, therefore, of great importance, and might have implications for everyday practice.…”

Global mortality of diabetic foot ulcer: A systematic review and meta‐analysis of observational studies

“…Of the 11 studies that analysed the impact of age on the mortality of patients with DFU, eight reported the HR and 95% CI per additional year. 16,18,21,24,30,32,33,35 The pooled HR for every 1-year increase of age was 1.054 (95% CI 1.045-1.063, P < .001). There was mild heterogeneity (I 2 = 33%) (Figure S3).…”

A review on contemporary nanomaterial-based therapeutics for the treatment of diabetic foot ulcers (DFUs) with special reference to the Indian scenario

“…Motor neuropathy activates atrophy in the foot muscles, causing osteomyelitis. 60 Sensory neuropathy causes disruption in the skin integrity and provides a route for microbial invasion, resulting in unhealed wounds, which later form chronic ulcers. 61 Autonomic neuropathy results in dysfunction of the sebaceous glands and sweat glands in the foot, leading to Nanoscale Advances Review a predisposition to ssures.…”