Examination of Underlying Lower Extremity Vascular Pathologies in Patients With Diabetic Foot Infection and Clinical Outcomes

Öz

Objective: Diabetes and vascular disorders raise the risk of diabetic foot infection and lower extremity amputation. Although DFI risk factors and microbiological analyses have been thoroughly researched, data for this specific group is limited. In this study, it was aimed to examine the underlying vascular risk factors of patients who were followed up and treated with the diagnosis of DFIs and clinical outcomes. Methods: Clinical, demographic, laboratory, microbiological, and foot examination data for 153 patients referred to our center for DFI between 2016 and 2021 were collected retrospectively from hospital information system. Results: The present center collected a total of 153 DFI patients during 5 year this period. There were 86 male and 67 women with a mean age of 67.71±15 years. There was 104 patients in non-vascular induced DFI group and 49 vascular induced DFI group. The top two comorbidities of DFI patients were cardiovascular disease and hypertension respectively. The rate of male patients was statistically higher in the vascular induced DFI group (p=0.003). Also hypertension and cardiovascular disease were more common in the vascular induced DFI group (p=0.0006, p=0.01). History of extremity amputation/debridement, having Wagner grade 5 DFI and Gram negative microorganism growth in tissue cultures were more common in the vascular induced DFI group (p=0.01, p=0.01 and p=0.0006). Extremity amputation/debridement rates were higher in the vascular induced DFI group (p=0.01) Conclusion: DFIs cause increased risk of amputation, prolonged antibiotic therapy, increased hospitalization, and increased healthcare costs as a result of investigations. Awareness of the vascular pathologies underlying DFIs can help clinicians manage the disease. The aim of this study is to emphasize the importance of vascular factors.

Anahtar Kelimeler

• diabetic foot infection
• vascular risk factors
• clinical outcomes

Diyabetik Ayak Enfeksiyonu Olan Hastalarda Alt Ekstremite Damar Patolojilerinin İncelenmesi ve Klinik Sonuçları

Öz

Amaç: Diyabet ve damar hastalıkları, diyabetik ayak enfeksiyonu (DAE) ve alt ekstremite amputasyonu riskini artırır. DAE risk faktörleri ve mikrobiyolojik analizler kapsamlı bir şekilde araştırılmış olmasına rağmen, bu özel grup için veriler sınırlıdır. Bu çalışmada DAE tanısı ile takip ve tedavi edilen hastaların altta yatan vasküler risk faktörlerinin ve klinik sonuçlarının incelenmesi amaçlandı. Yöntemler: 2016-2021 yılları arasında DAE için merkezimize başvuran 153 hastanın klinik, demografik, laboratuvar, mikrobiyolojik ve ayak muayene verileri hastane bilgi sisteminden geriye dönük olarak toplandı. Bulgular: Mevcut merkez, bu süre içinde 5 yıl boyunca toplam 153 DFI hastası topladı. Yaş ortalaması 67.71±15 yıl olan 86 erkek ve 67 kadın hasta vardı. Vasküler kaynaklı olmayan DAE grubunda 104, vasküler kaynaklı DAE grubunda 49 hasta vardı. DAE hastalarının ilk iki komorbiditesi sırasıyla kardiyovasküler hastalık ve hipertansiyondu. Vasküler kaynaklı DAE grubunda erkek hasta oranı istatistiksel olarak daha yüksekti (p=0,003). Ayrıca vasküler kaynaklı DFI grubunda hipertansiyon ve kardiyovasküler hastalık daha sıktı (p=0.0006, p=0.01). Ekstremite amputasyonu/debridman öyküsü, Wagner grade 5 DAE ve doku kültürlerinde Gram negatif mikroorganizma üremesi vasküler kaynaklı DAE grubunda daha sıktı (p=0.01, p=0.01 ve p=0.0006). Vasküler kaynaklı DAE grubunda ekstremite amputasyon/debridman oranları daha yüksekti (p=0.01) Sonuç: DAE’ları, yüksek ampütasyon riski, uzun süreli antibiyotik tedavisi, artan hastane yatışı ve tetkikler sonucu artan sağlık maliyetlerine neden olur. DAE’larının altında yatan vasküler patolojilerin farkındalığı, klinisyenlerin hastalığı yönetmesine yardımcı olabilir. Bu çalışmada amaç vasküler faktörlerin önemini vurgulamaktadır.

Anahtar Kelimeler

• diabetic foot infection
• vascular risk factors
• clinical outcomes

Kaynakça

1. 1. Bandyk DF. The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg. 2018;31(2-4):43-48. doi: 10.1053/j.semvascsurg.2019.02.001.
2. 2. Carro GV, Saurral R, Witman EL, et al. Ataque de pie diabético. Descripción fisiopatológica, presentación clínica, tratamiento y evolución [Diabetic foot attack. Pathophysiological description, clinical presentation, treatment and outcomes]. Medicina (B Aires). 2020;80(5):523-530.
3. 3. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sci. 2018;1411(1):153-165. doi: 10.1111/nyas.13569.
4. 4. Blume P, Wu S. Updating the Diabetic Foot Treatment Algorithm: Recommendations on Treatment Using Advanced Medicine and Therapies. Wounds. 2018;30(2):29-35.
5. 5. Sinwar PD. The diabetic foot management- recent advance. Int J Surg. 2015; 15:27-30. doi: 10.1016/j.ijsu.2015.01.023.
6. 6. Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981; 2:64-122.
7. 7. Lipsky BA, Berendt AR, Cornia PB, et al. Infectious Diseases Society of America. Executive summary: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012; 54:1679-1684.
8. 8. Altoijry A, AlGhofili H, Alanazi SN, et al. Diabetic foot and peripheral arterial disease. Single centre experience. Saudi Med J. 2021;42(1):49-55.

9. 9. Patil, SV, Mane, RR. Bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques. Int J Res Med Sci. 2017; 5:496-502.
10. 10. Citron DM, Goldstein EJ, Merriam CV, et al. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007; 45:2819-2828.
11. 11. Ramakant P, Verma AK, Misra R, et al. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia. 2011; 54:58-64.
12. 12. Thanganadar Appapalam S, Muniyan A, Vasanthi Mohan K, Panchamoorthy R. A Study on Isolation, Characterization, and Exploration of Multiantibiotic-Resistant Bacteria in the Wound Site of Diabetic Foot Ulcer Patients. Int J Low Extrem Wounds. 2021;20(1):6-14.
13. 13. Ertuğrul, MB, Uyar-Güleç, G, Baktıroğlu, S, Çörekli, E, Türe, M. The distribution of causative microorganisms in diabetic foot infection: has there been any alterations? Klimik Dergisi. 2017; 30:27-31.
14. 14. 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: diabetic foot infections in Turkey. Eur J Clin Microbiol Infect Dis. 2014; 33:871-878.
15. 15. Karmaker, M, Sanyal, SK, Sultana, M, Hossain, MA. Association of bacteria in diabetic and non-diabetic foot infection—an investigation in patients from Bangladesh. J Infect Public Health. 2016; 9:267-277.
16. 16. Saltoğlu, N, Kılıçoğlu, Ö, Baktıroğlu, S, et al. Diagnosis, treatment and prevention of diabetic foot wounds and infections: Turkish consensus report. Klimik Dergisi. 2015; 28:2-34.
17. 17. Körpinar Ş. A retrospective analysis of microbiologic profile of foot infections in patients with diabetic end-stage renal disease. Int J Low Extrem Wounds. 2021; 20:15-21.
18. 18. Vartanian SM, Robinson KD, Ofili K, et al. Outcomes of neuroischemic wounds treated by a multidisciplinary amputation prevention service. Ann Vasc Surg. 2015;29(3):534-542.
19. 19. Frykberg RG, Marston WA, Cardinal M. The incidence of lower-extremity amputation and bone resection in diabetic foot ulcer patients treated with a human fibroblast-derived dermal substitute. Adv Skin Wound Care. 2015;28(1):17-20. .