A prospective, multi-center study: Factors related to the management of diabetic foot infections

Abstract

The Turkish Association of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Working Group conducted a prospective study to determine the factors affecting the outcomes of diabetic foot infections.A total of 96 patients were enrolled in the study. Microbiological assessment was performed in 86 patients. A total of 115 causative bacteria were isolated from 71 patients. The most frequently isolated bacterial species was Pseudomonas aeruginosa (n0 21, 18.3%). Among cases with bacterial growth, 37 patients (43%) were infected with 38 (33%) antibiotic-resistant bacteria. The mean (±SD) antibiotics cost was 2,220.42 (±994.59) USD in cases infected with resistant bacteria, while it was 1,206.60 (±1,160.6) USD in patients infected with susceptible bacteria (p<0.001). According to the logistic regression analysis, the risk factors related to the growth of resistant bacteria were previous amputation (p00.018, OR07.229) and antibiotics administration within the last 30 days (p00.032, OR03.796); that related to the development of osteomyelitis was wound size >4.5 cm2 (p00.041, OR02.8); and that related to the failure of the treatment was the growth of resistant bacteria (p00.016, OR05.333). Diabetic foot osteomyelitis is usually a chronic infection and requires surgical therapy. Amputation is the accepted form of treatment for osteomyelitis. Limited limb-saving surgery and prolonged antibiotic therapy directed toward the definitive causative bacteria are most appropriate. This may decrease limb loss through amputations. As a result the infections caused by resistant bacteria may lead to a high cost of antibiotherapy, prolonged hospitalization duration, and failure of the treatment. © Springer-Verlag 2012.