Clinical outcomes in people with diabetes-related foot infections: Analysis from a limb preservation service infection database.

IF 2.5 3区医学 Q1 ORTHOPEDICS

Journal of Foot and Ankle Research Pub Date : 2024-09-01 DOI:10.1002/jfa2.12040

Matthew Malone, Emma Bergamin, Kenshin Hayashi, Saskia Schwarzer, Hugh G Dickson, Namson Lau, Lawrence A Lavery, Robert J Commons

{"title":"Clinical outcomes in people with diabetes-related foot infections: Analysis from a limb preservation service infection database.","authors":"Matthew Malone, Emma Bergamin, Kenshin Hayashi, Saskia Schwarzer, Hugh G Dickson, Namson Lau, Lawrence A Lavery, Robert J Commons","doi":"10.1002/jfa2.12040","DOIUrl":null,"url":null,"abstract":"Background: Diabetes-related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes-related foot infections.Methods: A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM) using chi-square tests.Results: Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST-DFI (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI a greater number of infection failures were observed in the presence of peripheral arterial disease (PAD) compared to the patients without PAD (failure occurred in 30% (31/103) of episodes with PAD and 12% (27/223) of episodes without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78).Conclusions: This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It highlights the association of PAD and treatment failure, reinforcing the need for early intervention to improve PAD in patients with DFI. Future randomised trials should assess the benefits of revascularisation and surgery in people with DFI and particularly those with OM where outcomes are worse.","PeriodicalId":49164,"journal":{"name":"Journal of Foot and Ankle Research","volume":"17 3","pages":"e12040"},"PeriodicalIF":2.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633327/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Foot and Ankle Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jfa2.12040","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Diabetes-related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes-related foot infections.

Methods: A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM) using chi-square tests.

Results: Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST-DFI (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI a greater number of infection failures were observed in the presence of peripheral arterial disease (PAD) compared to the patients without PAD (failure occurred in 30% (31/103) of episodes with PAD and 12% (27/223) of episodes without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78).

Conclusions: This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It highlights the association of PAD and treatment failure, reinforcing the need for early intervention to improve PAD in patients with DFI. Future randomised trials should assess the benefits of revascularisation and surgery in people with DFI and particularly those with OM where outcomes are worse.

查看原文本刊更多论文

糖尿病足感染患者的临床疗效：保肢服务感染数据库分析。

背景：与糖尿病相关的足部感染很常见，是一项重大的临床挑战。有关大型队列治疗效果的数据很少。本研究旨在报告一个大型糖尿病相关足部感染患者队列的临床结果：2018年，一家三级转诊医院建立了肢体保护服务数据库，并使用电子数据库（REDCap）前瞻性地采集了所有新发足部感染病例。纳入了2018年1月至2023年5月期间足部感染的患者，这些患者均有完整的感染发作数据。使用卡方检验比较了皮肤和软组织感染（SST-DFI）与骨髓炎（OM）的感染结果：数据提取确定了 397 名患者中 647 例完整的 DFI 病例。数据集被分为两组，每组确定一个感染病例及其严重程度为 SST-DFI（326 例，50%）或 OM（321 例，50%）。大多数感染表现被归类为中度（PEDIS 3 = 327，51%），36%为轻度（PEDIS 2 = 239），13%为重度（PEDIS 4 = 81）。69%的病例（449 例）感染缓解，31%的病例（198 例）感染失败。OM 感染失败比 SST-DFI 感染失败更常见（OM = 140，71% vs. SST-DFI = 58，29%，P 结论：这项研究提供了重要的流行病学数据，说明在澳大利亚环境中，DFI不良结局的风险以及与不良结局相关的因素。它强调了 PAD 与治疗失败之间的关联，强化了早期干预以改善 DFI 患者 PAD 的必要性。未来的随机试验应评估血管重建和手术对 DFI 患者的益处，尤其是对那些预后较差的 OM 患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Foot and Ankle Research ORTHOPEDICS-

CiteScore

4.50

自引率

10.30%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.