Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections

Wukich, Dane K.; Hobizal, Kimberlee B.; Sambenedetto, Tresa L.; Kirby, Kristin; Rosario, Bedda L.

doi:10.1177/1071100716664364

Cited by 54 publications

(37 citation statements)

References 32 publications

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“…In addition, although the quality of diabetes care in women appears to be higher than in men, the prevalence of DFU in women is higher than in men, which may be due to cultural differences in access to healthcare. Furthermore, in recent studies the duration of diabetes in patients with DFU has been noted as 11-16 years, 19,23,24 but in the Jae-Seung Yun et al 21 study this time has been reported as 6.1 years. This time is important to learn about diabetes and foot care.…”

Section: Discussionmentioning

confidence: 94%

“…Various studies have also reported the average age of patients with DFU as between 40-55 years. 19,21,23 There is no significant reason for DFU incidence in middle-age persons but this can be due to the higher prevalence of diabetes in middle-age than in other age groups. In addition, although the quality of diabetes care in women appears to be higher than in men, the prevalence of DFU in women is higher than in men, which may be due to cultural differences in access to healthcare.…”

Section: Discussionmentioning

confidence: 99%

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<p>Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah</p>

Ghobadi

Sarbarzeh

Jalilian

et al. 2020

DMSO

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Introduction: Diabetes mellitus is a metabolic disease characterized by high blood sugar (BS) levels and the change in the metabolism of lipids, carbohydrates, and insulin resistance, and is one of the main causes of disability and mortality worldwide. Among the different types of complications, which have many negative effects on personal and social life, diabetic foot ulcer (DFU) is very important. This study aims to investigate the factors affecting the severity of DFU among patients with diabetes. Methods: The study participants included 190 diabetic patients with a diagnosis of DFU. Data were collected using a two-part questionnaire for self-care awareness and functions in diabetic patients and Wagner's scale. The questionnaire was answered in cooperation with patients and the Wagner's score was estimated by a wound supervisor in the diabetes center. Results: There was 109 women (57.4%). Twenty-six patients had other diabetic complications as well as DFU. The average score of awareness in patients was 6.99±2.76 and the function was 62.22±9.92. The results found a direct relation between the age and the duration of illness with the score of the patient's awareness (P=0.008, P=0.000). There was also a direct relation between the level of education with score of awareness and the score of function in self-care (P=0.000, P=0.000), but the statistical results did not find any relation between awareness and the function in self-care of patients with the severity of DFU (P>0.05). Discussion: There was no relation between the self-care awareness and function with severity of DFU (P>0.05) that can be due to the more relation between DFU severity with hygiene and physical factors after the disease and the effect of awareness and function would be only in the incidence of the DFU. Conclusion: Awareness and function of patients in self-care is less than average. Increasing awareness of patients and empowering them through appropriate training can be effective in preventing diabetic foot ulcers.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

<p>Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah</p>

Ghobadi

Sarbarzeh

Jalilian

et al. 2020

DMSO

View full text Add to dashboard Cite

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“…The overall amputation rate did not differ significantly between the patients treated for osteomyelitis outside the Charcot region and those treated for osteomyelitis within the Charcot region. Wukich et al [ 28 ] recently reported 16 of 43 patients (37.2%) with CN hospitalized for osteomyelitis underwent major amputation, but this rate can be expected to be lower in less severe cases that can be effectively managed in an outpatient setting such as ours. When considering the level of amputation, the 20% rate of major amputations we reported in cases of osteomyelitis within the Charcot region is comparable to the 23% rate of major amputations reported by Gazis et al [ 29 ] in 47 patients with CN managed by a specialist diabetic foot clinic.…”

Section: Discussionmentioning

confidence: 82%

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

Berli

Vlachopoulos

Leupi

et al. 2017

BMC Musculoskelet Disord

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BackgroundWe evaluated treatment of osteomyelitis in the foot in the presence of Charcot neuroarthropathy, a devastating condition with progressive degeneration and joint destruction. We hypothesized that there was a difference in (1) amputation rate, (2) amputation level, (3) duration of antibiotic therapy, and (4) duration of immobilization for treatment of osteomyelitis within versus outside the Charcot zone.MethodsForty patients (43 ft) diagnosed with Charcot neuroarthropathy and osteomyelitis of the same foot were retrospectively analyzed. Some patients were successfully treated for osteomyelitis at different sites on the same foot at different times, thus 60 cases of osteomyelitis were identified in 40 treated patients. Cases were divided according to osteomyelitis localization: Group 1 had osteomyelitis outside the active Charcot region; Group 2 had osteomyelitis within the active Charcot region.ResultsMale patients (n = 29; mean age 58.2, range 40.1 to 77.5 years) were younger than female patients (n = 11; mean age 70.4, range 51.4 to 87.5, p = 0.02 years). Amputation rate was 52% overall (26/40 patients; 26/43 ft): 63% of 30 Group 1 cases and 40% of 30 Group 2 cases (p = 0.09). Amputation level (p = 0.009), duration of antibiotic treatment (p = 0.045) and duration of immobilization (p = 0.01) differed significantly between the groups.ConclusionsOsteomyelitis within the Charcot region is associated with a higher level of amputation and longer durations of antibiotic therapy and immobilization. Osteomyelitis outside and within the Charcot affected region should be considered separately. If osteomyelitis occurs outside the active Charcot region, primary amputation may be preferred to internal resection.Level of EvidenceRetrospective cohort chart review study.

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“…During hospitalization, patients with OM have more surgeries, more amputations, longer hospitalizations, and longer antibiotic exposure than patients with soft tissue infections (STIs), and they are more likely to be readmitted to hospital for an infection. After hospital discharge, up to 48% of patients develop reinfection and require rehospitalization 3,4 . If recurrent OM can be identified early with serum biomarkers, treatments could be initiated earlier and more severe complications such as surgery, amputation, and hospitalization might be avoided.…”

Section: Introductionmentioning

confidence: 99%

The infected diabetic foot: Can serum biomarkers predict osteomyelitis after hospital discharge for diabetic foot infections?

Crisologo

Davis

Ahn

et al. 2020

Wound Repair Regeneration

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The aim of this study is to evaluate serum biomarkers to monitor high‐risk patients for reinfection of bone. Thirty‐five patients were prospectively enrolled with moderate to severe diabetic foot infections with suspicion of osteomyelitis. Bone samples were obtained for culture and histology. Clinical characteristics and outcomes of patients were compared using χ2 square test. Biomarkers (white blood cell count, erythrocyte sedimentation rate, c‐reactive protein, procalcitonin, interleukin‐6, interleukin‐8, and monocyte chemoattractant protein 1) were assessed at baseline, 3, and 6 weeks after treatment initiation and evaluated for correlation with reinfection of bone. After 6 weeks of antibiotic treatment, ESR at 73.5 mm/h (sensitivity 62.5%, specificity 100%, area under the receiver operating characteristic (AUROC) 0.7839, 95% CI 0.54‐1.00, P < .01) and IL‐8 at 15.09 mg/dL (sensitivity 42.9%, specificity 92.0% AUROC 0.6286, 95% CI 0.36‐0.90, P = .0496) were associated with reinfection of bone. An increase in IL‐8 from week 0 to 6 >0.95 mg/dL was associated with reinfection (sensitivity 71%, specificity 72% AUROC 0.7057, 95% CI 0.49‐0.92, P = .04). An ESR change from week 0‐6 of −16.5% (sensitivity 71.4%, specificity 86.4% AUROC 0.7403, 95% CI 0.48‐1.00, P = .02), CRP (‐)74.4% (sensitivity 66.7%, specificity 91.3% AUROC 0.7174, 95% CI 0.40‐1.00, P = .04), IL‐6 (‐)49.9% (sensitivity 71.4%, specificity 76% AUROC 0.7371, 95% CI 0.47‐1.00, P = .04), and IL‐8 29% (sensitivity 85.7%, specificity 56.0% AUROC of 0.7343, 95% CI 0.54‐0.93, P = .048) were associated with increased risk of reinfection. Pilot data suggest that serum biomarkers (ESR, IL8 and IL6, MCP‐1) may be correlated with developing osteomyelitis and could be used to monitor high‐risk patients for reinfection.

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Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections

Cited by 54 publications

References 32 publications

<p>Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah</p>

<p>Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah</p>

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

The infected diabetic foot: Can serum biomarkers predict osteomyelitis after hospital discharge for diabetic foot infections?

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