An evaluation of risk factors affecting amputation in patients with diabetic foot infection
Yıl: 2021 Cilt: 4 Sayı: 1 Sayfa Aralığı: 49 - 54 Metin Dili: İngilizce DOI: 10.32322/jhsm.809986 İndeks Tarihi: 02-08-2021
An evaluation of risk factors affecting amputation in patients with diabetic foot infection
Öz: Introduction: Diabetic foot infections are one of the most common complications of diabetes and generally result in lowerextremity amputations.Aim: The purpose of this study is to investigate risk factors affecting amputation in patients diagnosed with diabetic foot ulcer.Material and Method: This prospective cohort study involved 137 patients diagnosed with diabetic foot infection in a universityhospital diabetic foot clinic.Results: The mean age of the participants was 60.5±10.1 years, and 70.8% (n=97) were men. The majority of patients (62.0%)were educated to elementary or middle school level, while 26.3% were illiterate. Mean duration of diabetes was 13.3±6.2years. Hypertension was present in 48.2% of patients, hypercholesterolemia in 31.4%, cardiovascular disease (CVD) in 38%,peripheral artery disease (PAD) in 21.2%, peripheral venous insufficiency in 10.2%, and polyneuropathy in 70.1%, and 9.5%were receiving hemodialysis. According to the PEDIS classification, moderate foot ulcers were present in 60.6% of patients, mildulcers in 34.3%, and severe ulcers in 5.1%. Forty-six percent of patients were diagnosed with osteomyelitis during follow-up.Amputation was present in 28.5% (n=39) of the patients followed-up due to foot ulcers. PAD increased the risk of amputation2.7-fold (95% CI: 1.02-7.14), osteomyelitis 2.6-fold (95% CI: 1.10-6.16), and repeated hospitalizations 5.9-fold (95% CI: 2.25-15.33). Growth was observed in 72.6% of patients without amputation, 76.5% were polymicrobial, and 65.9% of antibiogramresults were multidrug resistant. No significant difference was observed among the patients in terms of multidrug resistance(p=0.468).Conclusion: PAD, osteomyelitis, and history of repeated hospitalizations are separate risk factors for amputation in patientswith diabetic foot ulcers.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. International Diabetes Federation, IDF Diabetes Atlas, International Diabetes Federation, Brussels, Belgium, 8th edition, 2017.
- 2. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med 2017; 49: 106-16.
- 3. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev 2000; 16 Suppl 1: S75-S83.
- 4. Chronic Complications of Diabetes, Diabetes and Foot. National Diabetes Consensus Group. TURKDIAB Diabetes Diagnosis and Treatment Guideline. 2019; 121-30.
- 5. Brownrigg JRW, Griffin M, Hughes CO, et al. Influence of foot ulceration on cause-specific mortality in patients with diabetes mellitus. J Vasc Surg 2014; 60: 982–6.
- 6. Turhan V, Mutluoglu M, Acar A, et al. Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers. J Infect Dev Ctries 2013; 7: 707-12.
- 7. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med 2017; 376: 2367-75.
- 8. Spicler A, Hurwitz BL, Armstrong DG, Lipsky BA. Microbiology of diabetic foot infections: from Luis Pasteur to ‘crime scene investigation’. BMC Med 2015; 13: 1-13.
- 9. The International Working Group on the Diabetic Foot. International consensus on diagnosing and treating the infected diabetic foot. 4th International symposium on the diabetic foot. Noordwijkenhout-The Netherlans. 22-24 May 2003. Schaper NC. Diabetes Metab Res Rev 2004; 20: 90-5.
- 10.Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268-81.
- 11.Barwell ND, Devers MC, Kennon B, et al. Diabetic foot infection: Antibiotic therapy and good practice recommendations. Int J Clin Pract 2017; 71: 10.1111/ijcp.13006.
- 12.Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev 2000; 16: 75-83.
- 13.Baba M, Davis WA, Norman PE, Davis TM. Temporal changes in the prevalence and associates of diabetes-related lower extremity amputations in patients with type 2 diabetes: the Fremantle Diabetes Study. Cardiovasc Diabetol. 2015; 14: 1-10.
- 14.De Jesus-Silva SG, De Oliveira JP, Colepicolo Brianezi MH, De Moraes Silva MA, Krupa AE, Cardoso RS. Analysis of risk factors related to minor and major lower limb amputations at a tertiary hospital. J Vasc Bras 2017; 16: 16-22.
- 15.Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2016; 13: 13-9.
- 16.Moon KC, Kim SB, Han SK, Jeong SH, Dhong ES. Risk factors for major amputation in hospitalized diabetic patients with forefoot ulcers. Diabetes Res Clin Pract 2019; 158: 107905.
- 17.Al-Mahroos F, Al-Roomi K. Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinicbased study. Ann Saudi Med 2007; 27: 25-31.
- 18.Bruun C, Siersma V, Guassora AD, Holstein P, de Fine Olivarius N. Amputations and foot ulcers in patients newly diagnosed with type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity. Diabet Med 2013; 30: 964-72.
- 19.Larsson LG, Baum J, Mudholkar GS. Hypermobility: features and differential incidence between the sexes. Arthritis Rheum 1987; 30: 1426-30.
- 20.Cheng YJ, Gregg EW, Kahn HS, Williams DE, De Rekeneire N, Narayan KM. Peripheral insensate neuropathy--a tall problem for US adults? Am J Epidemiol 2006; 164: 873-80.
- 21.Hjelm K, Nyberg P, Apelqvist J. Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions. J Adv Nurs 2002; 40: 673-84.
- 22.Orneholm H, Apelqvist J, Larsson J, Eneroth M. High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes. Wound Repair Regen 2015; 23: 922-31.
- 23.Al-Rubeaan K, Youssef AM, Ibrahim HM, et al. All-cause mortality and its risk factors among type 1 and type 2 diabetes mellitus in a country facing diabetes epidemic. Diabetes Res Clin Pract. 2016; 118: 130-9.
- 24.Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care 1999; 22: 1036-42.
- 25.Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, Khader YS, Garaibeh K, Heis HA. Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Diabetes Metab Syndr Obes 2018; 11: 313-9.
- 26.Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–31.
- 27.Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K. Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. J Diabetes Complications 2007; 21: 341–9.
- 28.Cardoso HC, Zara ALSA, Rosa SSRF, et al. Risk factors and diagnosis of diabetic foot ulceration in users of the Brazilian public health system. J Diabetes Res 2019; 2019: 5319892.
- 29.Namgoong S, Jung S, Han SK, Jeong SH, Dhong ES, Kim WK. Risk factors for major amputation in hospitalised diabetic foot patients. Int Wound J 2016; 13 Suppl 1: 13-9.
- 30.Al-Rubeaan K, Al Derwish M, Ouizi S, et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One 2015; 10: e0124446.
- 31.Khawaja N, Abu-Shennar J, Saleh M, Dahbour SS, Khader YS, Ajlouni KM. The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; the case of Jordan. Diabetol Metab Syndr 2018; 10: 8.
- 32.Faglia E. Characteristics of peripheral arterial disease and its relevance to the diabetic population. Int J Low Extrem Wounds 2011; 10: 152–66.
- 33.Bozkurt F, Tekin R, Çelen MK, Celal A. Diyabetik ayak enfeksiyonlu hastalarda Wagner sınıflaması ve kültür sonuçlarının değerlendirilmesi. Dicle Tıp Dergisi. 2011; 38: 31-4.
- 34.Oliveira AFD, Oliveira Filho HD. Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections. J Vasc Bras 2014; 13: 289-93
- 35.Oliva A, Giacobbe DR, Di Luca M, Miller NS. New insights into infections due to multidrug resistant gram negative Bacteria: The Interplay between Lab and Clinic. Biomed Res Int 2018; 2018: 8905874.
APA | Alay H, Yılmaz S, KESMEZ CAN F, Parlak M (2021). An evaluation of risk factors affecting amputation in patients with diabetic foot infection. , 49 - 54. 10.32322/jhsm.809986 |
Chicago | Alay Handan,Yılmaz Sinan,KESMEZ CAN Fatma,Parlak Mehmet An evaluation of risk factors affecting amputation in patients with diabetic foot infection. (2021): 49 - 54. 10.32322/jhsm.809986 |
MLA | Alay Handan,Yılmaz Sinan,KESMEZ CAN Fatma,Parlak Mehmet An evaluation of risk factors affecting amputation in patients with diabetic foot infection. , 2021, ss.49 - 54. 10.32322/jhsm.809986 |
AMA | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M An evaluation of risk factors affecting amputation in patients with diabetic foot infection. . 2021; 49 - 54. 10.32322/jhsm.809986 |
Vancouver | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M An evaluation of risk factors affecting amputation in patients with diabetic foot infection. . 2021; 49 - 54. 10.32322/jhsm.809986 |
IEEE | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M "An evaluation of risk factors affecting amputation in patients with diabetic foot infection." , ss.49 - 54, 2021. 10.32322/jhsm.809986 |
ISNAD | Alay, Handan vd. "An evaluation of risk factors affecting amputation in patients with diabetic foot infection". (2021), 49-54. https://doi.org/10.32322/jhsm.809986 |
APA | Alay H, Yılmaz S, KESMEZ CAN F, Parlak M (2021). An evaluation of risk factors affecting amputation in patients with diabetic foot infection. Journal of health sciences and medicine (Online), 4(1), 49 - 54. 10.32322/jhsm.809986 |
Chicago | Alay Handan,Yılmaz Sinan,KESMEZ CAN Fatma,Parlak Mehmet An evaluation of risk factors affecting amputation in patients with diabetic foot infection. Journal of health sciences and medicine (Online) 4, no.1 (2021): 49 - 54. 10.32322/jhsm.809986 |
MLA | Alay Handan,Yılmaz Sinan,KESMEZ CAN Fatma,Parlak Mehmet An evaluation of risk factors affecting amputation in patients with diabetic foot infection. Journal of health sciences and medicine (Online), vol.4, no.1, 2021, ss.49 - 54. 10.32322/jhsm.809986 |
AMA | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M An evaluation of risk factors affecting amputation in patients with diabetic foot infection. Journal of health sciences and medicine (Online). 2021; 4(1): 49 - 54. 10.32322/jhsm.809986 |
Vancouver | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M An evaluation of risk factors affecting amputation in patients with diabetic foot infection. Journal of health sciences and medicine (Online). 2021; 4(1): 49 - 54. 10.32322/jhsm.809986 |
IEEE | Alay H,Yılmaz S,KESMEZ CAN F,Parlak M "An evaluation of risk factors affecting amputation in patients with diabetic foot infection." Journal of health sciences and medicine (Online), 4, ss.49 - 54, 2021. 10.32322/jhsm.809986 |
ISNAD | Alay, Handan vd. "An evaluation of risk factors affecting amputation in patients with diabetic foot infection". Journal of health sciences and medicine (Online) 4/1 (2021), 49-54. https://doi.org/10.32322/jhsm.809986 |