Diabetic foot infections: effective microorganisms and factors affecting the frequency of osteomyelitis and amputation

Year 2015, Volume: 1 Issue: 3, 119 - 127, 04.11.2015

Meliha Sonmezer Necla Tulek Metin Ozsoy Fatma Erdinc Gunay Ertem

https://doi.org/10.18621/eurj.2015.1.3.119

Cited By: 1

Abstract

Objectives. Diabetic foot infections are common reason for hospitalization and are associated with high morbidity and mortality. We aimed to evaluate the clinic features and predisposed causes of osteomyelitis and amputation of patients with diabetic foot infections. Methods. Patients with diabetic foot infections who admitted and hospitalized at Infection Diseases and Clinical Microbiology department between January 2012 and July 2014 were included. Osteomyelitis was evaluated using magnetic resonance imaging (MRI) or bone scintigraphy. Microbiological examinations (Gram staining and culture) of the debridement materials and pus aspiration materials of the lesions were performed. Results. Of the seventy-three diabetic foot infected patients, 37 (50.7%) were female, and 36 (49.3%) were male. The mean age of patients was 57±9.8 years. The mean duration of diabetes and HbA1c level were 13.3±5.3 years and 8.17±1.83%; respectively. Soft tissue infection without osteomyelitis was present in only 34 out of 73 (46.5%) patients. A total of 89 pathogens were identified in 52 patients whereas any microorganism was not identified in 28.7%. Polymicrobial infections were detected in 30 (41%) patients. The most common isolated microorganism was Pseudomonas aeruginosa (36.9%), followed by Staphylococcus aureus (31.5%) and Enterococcus spp. (13.6%). Of the 37 (50.7%) patients had a history of diabetic foot infection previously, osteomyelitis progression was higher (89.2%) and statistically significant in these patients. Twelve (16.4%) patients underwent amputation. Conclusions. Advanced age and presence of osteomyelitis were found as risk factors for amputation. In the presence of osteomyelitis, treatment of diabetic foot infections is difficult and amputation rate is higher. For this reason, diabetic foot infections should be promptly treated before the development of osteomyelitis, and multidisciplinary approach is needed.

Keywords

Diabetic foot infection, osteomyelitis, amputation

References

• Ertugrul B, Oncul O, Willke A, Tulek N, Sacar S, Tunccan G, et al. A prospective, multi-center study: factors related to the management of diabetic foot infections. Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2345-52.
• Swartz MN, Pasternack MS. Cellulitis and subcutaneous tissue infections. In: Mandell GL, Bennet JE, Dolin R, eds. Mandell, Douglas, and Bennet’s Principles and Practice of Infectious Diseases. Seventh ed. Philadelphia: Churchill Livingstone, 2010:1300-2.
• Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. 2013:Jan-Feb;103(1):2-7.
• Monteiro-Soares M, Martins-Mendes D, Vaz-Carneiro A, Sampaio S, Dinis-Ribeiro M. Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev. 2014 Oct;30(7):610-22.
• Wagner FW Jr. A classification and treatment program for diabetic neuropathic and dysvascular foot problems, in AAOS. Inst Course Lect. 1979;28:143-65.
• Lipsky BA. Osteomyelitis of the foot in diabetic patients. Clin Infect Dis. 1997 Dec;25(6):1318-26
• Hatipoglu M, Mutluoglu M, Uzun G, Karabacak E, Turhan V, Lipsky BA. The microbiologic profile of diabetic foot infections in Turkey: a 20-year systematic review. Eur J Clin Microbiol Infect Dis. 2014 Jun;33(6):871-8.
• Noviello S, Esposito I, Pascale R, Esposito S, Zeppa P. [Diabetic foot infections: microbiological aspects]. Infez Med. 2012;20 Suppl 1:20-7.
• Ertugrul B, Baktiroglu S, Salman S, Unal S, Aksoy M, Berberoglu K, et al. Pathogens isolated from deep soft tissue and bone in patients with diabetic foot infections. J Am Podiatr Med Assoc. 2008 Jul-Aug;98(4):290-5.
• Balakrishnan S, Shahid NJ, Fairuz T, Ramdhan I. ‘Does the National Antibiotic Guideline- 2008 remain applicable for treating diabetic foot infection?’ A new evidence-based regional study on culture and sensitivity patterns in Terengganu population. Malays Orthop J. 2014 Mar;8(1):42-4.
• Clinical and Laboratory Standards Institute: Performance Standards for Antimicrobial Susceptibility Testing; CLSI/NCCLS Document M100-S15, CLSI, Wayne, PA, 2005.
• Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992 Jul 15;117(2):97-105.
• Perrin B. A retrospective audit of a diabetic foot clinic. Australas J Podiatr Med. 2006;40:23-5.
• Zaine HN, Burns J, Vicaretti M, Fletcher JP, Begg L, Hitos K. Characteristics of diabetic foot ulcers in Western Sydney, Australia. J Foot Ankle Res. 2014 Sep 28;7(1):39.
• Levin ME. Management of the diabetic foot: preventing amputation. South Med. J 2002 Jan;95(1):10-20.
• Durgun O, Durgun AG, Ersoy CO, Almacıoglu S, Karadayı D, Ozkaya G, et al. A retrospective evaluation of factors that determine the necessities of amputation in diabetic foot patients. Uludag Med J. 2012;38(2):59-62.
• Mantey I, Foster AV, Spencer S, Edmonds ME. Why do foot ulcers recur in diabetic patients? Diabet Med. 1999 Mar;16(3):245-9.
• Connor H, Mahdi OZ. Repetitive ulceration in neuropathic patients. Diabetes Metab Res Rev. 2004 May-Jun;20(Suppl 1):S23-8.
• Moss SE, Klein R, Klein BE. The prevalence and insidence of lower extremity amputation in a diabetic population. Arch Intern Med. 1992 Mar;152(3):610-6.
• Savas MC, Sozen T, Bayraktar M. Investigation of Risk Factors on 84 Patients with Diabetic Foot. Turkish Diabetes Annual. 1994-1995;10:127-30.
• Demirci H, Akturk M, Karakoç A, Toruner F, Yetkin I, Ayvaz G, et al. Incidence of microvascular complications and their association with osteomyelitis in patients with diabetic foot ulcers. Gazi Med J. 2006;17(4):209-12.
• Bozkurt F, Tekin R, Celen MK, Ayaz C. Wagner classification and culture analysis of diabetic foot infection. Dicle Med J. 2011;38(1): 31-4.
• West NJ. Systemic antimicrobial treatment of foot infections in diabetic patients. Am J Health-Syst Pharm. 1995 Jun 1;52(11):1199-207.
• Frykberg RG. An evidence based approach to diabetic foot infections. Am J Surg. 2003 Nov 28;186(5A):44S-54S; discussion 61S-64S.
• Ozkan Y, Colak R, Demirdag K, Yildirim MA, Ozalp G. Retrospective evaluation of 142 cases with diabetic foot syndrome. Turkiye Klinikleri J Endocrin. 2004;2:191-5.
• Tan JS, Wishnow RM, Talan DA, Duncanson FP, Norden CW. Treatment of hospitalized patients with complicated skin and skin structure infections: double-blind, randomized, multicenter study of piperacillin-tazobactam versus ticarcillin-clavulonate.The Piperacillin/Tazobactam Skin and Skin Structure Study Group. Antimicrob Agents Chemother. 1993 Aug;37(8):1580-6.