Risk factors for amputation in patients with diabetic foot infection: a prospective study

Abstract

There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well-known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.

Meta‐analysis of risk factors for amputation in diabetic foot infections

“…Diabetic complications, including PAD, peripheral neuropathy, nephropathy, and severe infection, were identified as major causes of amputation . Arterial insufficiency increases the risk of amputation by prolonging the healing process .…”

“…Diabetic complications, including PAD, peripheral neuropathy, nephropathy, and severe infection, were identified as major causes of amputation. 1,11,23,28,32 Arterial insufficiency increases the risk of amputation by prolonging the healing process. 25 Although PAD and the severity of infection posed a greater risk for a high amputation rate, peripheral neuropathy was not an important factor in some of the studies.…”

Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature

“…We also found male (52.9%) dominance in our study since acute occupational hand injuries are more common in males in this country (42). In addition, the male sex is more common among diabetic foot cases (43). This situation was also found to be high in favor of men in the pool analysis.…”

“…In the pool analysis of the literature, this rate was 7.83%, similar to our findings. It is known that fungal etiology is associated with the risk of amputation, especially in diabetic foot cases (43). Progression to amputation in one patient with fungal infection suggests that fungal etiology may also be associated with poor outcome of treatment in diabetic hand infections.…”

Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections

“…We could not find any significant relationship with age, sex, osteomyelitis, previous amputation, previous DFI, ulcer duration, or HbA1c. Poor glycemic control, peripheral neuropathy, previous DFI, and ulcer depth and duration have been reported as other independent risk factors for amputation in the literature (19,20). S. aureus, streptococci, gram-negative bacilli, and anaerobic bacteria are the most frequently detected pathogens in DFIs, and their prevalence may vary with the duration and severity of infection, antibiotic use, duration of hospitalization, presence of osteomyelitis, and geographical area (3,21,22).…”