Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up

Article Article scientifique Article Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up eng 1999 author Pittet Didier 117792 author Wyssa Blaise Jean Albert 66905 author Herter-Clavel Catherine 27867 author Kursteiner K. author Vaucher J author Lew Daniel Pablo 26516 851-856 10.1001/archinte.159.8.851 10219931 0003-9926 http://archinte.ama-assn.org/cgi/reprint/159/8/851.pdf BACKGROUND: Diabetic foot lesion is associated with increased morbidity and high resource use. Although early amputation has been advocated in case of osteomyelitis, conservative treatment is a more attractive alternative. OBJECTIVE: To identify criteria predictive of failure of conservative treatment of diabetic foot ulcer at time of admission to the hospital. METHODS: We conducted a 5-year retrospective cohort study with prospective long-term follow-up of all diabetic patients admitted for a foot lesion at a large (1600-bed) teaching institution. Predetermined criteria were used for the diagnosis and classification of diabetic foot lesions (Wagner classification). Study variables included patient demographics and clinical parameters related to infection and diabetes. The average follow-up after hospital discharge was 2 years. Failure of conservative treatment was the main outcome measure. Independent predictor variables were selected by logistic regression analysis. RESULTS: A total of 120 diabetic patients were admitted for foot lesions; complications of contiguous osteomyelitis, deep tissue involvement, and/or gangrenous lesions occurred in 78 (74%) of the 105 patients for whom charts were available. Fourteen patients (13%) underwent immediate amputation. Conservative treatment was successful for 57 (63%) of the 91 remaining patients. Success was achieved in 21 (81%) of 26 patients presenting with skin ulcer, 35 (70%) of 50 patients with deep tissue infection or suspected osteomyelitis, and 1 (7%) of 15 patients with gangrene (P<.001, chi2 for trend). Independent factors predictive of failure were the presence of fever (odds ratio [OR]=1.1 per degrees Celcius; 95% confidence interval [CI], 1.0-1.2) and increased serum creatinine level (OR=1.002 per micromoles per liter; 95% CI, 1.0020-1.0021) on admission, prior hospitalization for diabetic foot lesion (OR=1.4; 95% CI, 1.2-1.6), and gangrenous lesion (OR=1.8; 95% CI, 1.5-2.2). Other patient characteristics, demographics, duration of diabetes mellitus, neutrophil count, or the anatomical site of the lesion failed to predict outcome. CONCLUSIONS: Conservative treatment, including prolonged, culture-guided parenteral and oral antibiotics, is successful without amputation in a large proportion of diabetic patients admitted for a foot skin ulcer or suspected osteomyelitis. Future studies comparing early amputation with novel therapeutic strategies for severe diabetic foot infection should take into account currently identified factors that predicted failure of conservative treatment on admission to the hospital. Adult Aged Aged, 80 and over Diabetic Foot/diagnosis/drug therapy/ microbiology/ therapy Diagnosis, Differential Female Follow-Up Studies Humans Logistic Models Male Middle Aged Odds Ratio Predictive Value of Tests Retrospective Studies Treatment Outcome Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 false 74 Chirurgie orthopédique et traumatologique 98 251 Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière 330 Archives of internal medicine 159 8 51e945aa-c379-41b2-91fe-877cd7eb8aee Article Restricted file1.pdf 195428 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up	Archives of internal medicine			1999	526	0

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Herter-Clavel, Catherine