The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds

Mutluoğlu, Mesut; Sivrioğlu, Ali Kemal; Eroğlu, Murat; Uzun, Günalp; Turhan, Vedat; Ay, Hakan; Lipsky, Benjamin A.

doi:10.3109/00365548.2013.765589

Cited by 100 publications

(73 citation statements)

References 24 publications

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“…Duration of antibiotic treatment, length of hospital stay, the duration of infection before initiation of treatment were longer in the 121 cases with osteomyelitis in our study compared to other patients. Mutluoğlu et al compared patients with and without osteomyelitis; and found that length of hospital stay and antibiotic treatment, time before initiation of treatment and wound healing times were longer and more surgical interventions were required for patients with osteomyelitis [20].…”

Section: Accepted Manuscriptmentioning

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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Section: Accepted Manuscriptmentioning

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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“…In a study of hospitalized patients with DFIs, minor amputation was significantly higher in patients with osteomyelitis than in patients with SSTIs (59.4% vs 13.8%). 10 Prior amputation is associated with increased risk of hospitalization. 11 Minor amputations alter the architecture of the foot and make the patient prone to further ulceration.…”

Section: Introductionmentioning

confidence: 99%

Management of Hospitalized Patients with Diabetic Foot Infections

Bader

Alavi

2014

Hospital Practice

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Diabetic foot infections (DFIs), which present with a variety of clinical manifestations, are commonly encountered by clinicians. They are associated with a high morbidity, a high amputation rate, a high mortality, and increased health care costs. An effective management of DFIs requires a multidisciplinary approach with a strong collaboration among all involved health care providers as well as patient involvement. Diagnosing DFIs appropriately requires consideration of the clinical symptoms and signs of infection in addition to supplementary laboratory testing such as inflammatory markers and imaging studies. The comprehensive patient assessment should include the predisposing risk factors for infection; the type, severity, and extent of the infection; and the assessment of neurologic and vascular status, comorbid conditions, and psychosocial factors. The comprehensive management of DFIs include not only effective antibiotic therapy but also surgical debridement, pressure offloading, wound care and moisture, maintaining good vascular perfusion, control of edema and pain, correction of metabolic abnormalities such as hyperglycemia, and addressing psychosocial and nutritional issues. Discharge planning that addresses full medical and social needs along with suitable follow-up, patient education and counseling, and clear communication with outpatient providers are critical for ensuring a safe and successful transition to outpatient management of hospitalized patients with DFIs.

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“…A closer look at Table 1 in Santema et al (1) shows that patients in the standard care arm had significantly lower grade wounds (in total, 42% patients had Wagner grade III and IV wounds in the standard care arm vs. 55% in the HBOT arm). The fact that wounds with Wagner grade III and IV have a very high likelihood of osteomyelitis and that patients with osteomyelitis almost always suffer amputation (3) causes a bias toward worse outcomes in the HBOT arm.…”

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confidence: 99%

Comment on Santema et al. Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower-Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial. Diabetes Care 2018;41:112–119

The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds

Abstract: The presence of osteomyelitis negatively affects both the treatment and outcome of diabetic foot infections.

Cited by 100 publications

References 24 publications

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

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

Management of Hospitalized Patients with Diabetic Foot Infections

Comment on Santema et al. Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower-Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial. Diabetes Care 2018;41:112–119

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