630-P: Systemic Inflammatory Response Syndrome (SIRS) Criteria as a Predictor of Clinical Outcomes in Diabetic Foot Infections

Abstract

Aim: Previous investigations have identified presence of systemic inflammatory response syndrome (SIRS) as an indicator of severe foot infection in patients with diabetes mellitus (DM). The aim of this study was to assess whether SIRS is correlated with outcomes in patients with diabetic foot infections (DFI). Methods: We retrospective reviewed 173 diabetic patients admitted to hospital with moderate and severe DFI according to Infectious Diseases Society of America (IDSA) guidelines confined to skin and soft tissue infection. We used SIRS criteria to define severe infection based on the presence of at least two of the following: heart rate >90 beats per minute, temperature >38°C or <36°C, respiratory rate >20 breaths per minute and white blood cell count >12,000/mm3 or <4,000/mm3. Results: Of the 173 subjects, 50 (36.5%) met SIRS criteria. Patients with severe infections based on SIRS criteria were significantly younger (49.0±10.4 vs. 54.2±10.8 years, p=0.014), more often had type 1 DM (10.0% vs. 1.1%, p=0.032), less often had a history of a previous foot ulcer (48.0% vs. 66.7%, p=0.040) and had longer hospital stay (8.0±6.1 vs. 11.7±11.3 days, p=0.024). There was not a significant difference in the number of surgical procedures (1.1±1.4 vs. 1.2±1.4, p=0.40), amputation procedures (24% vs. 27.6%, (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.33, 1.720), duration of antibiotic treatment (30.1±42.5 vs. 31.6±48.5 days, p=0.47), proportion of healed wounds (74.0% vs. 66.7%, p=0.304), time to healing (142.6±102.8 vs. 131.9±103.1 days, p=0.67). reinfection (34.0% vs. 42.5%, p=0.29), hospital readmission (30.0% vs. 47.1%, p=0.072) or mortality (4.0% vs. 5.7%, p=1.0). Conclusion: SIRS criteria for severe infections in diabetic patients with skin and soft tissue infections were not associated with worse outcomes other than longer hospital stay. Further investigation is needed to identify factors that portend worse outcome in those with foot STI in the setting of DM. Disclosure J. Ahn: None. E.C. Ryan: None. D. Wukich: Consultant; Self; Orthofix. Other Relationship; Self; Arthrex. J. La Fontaine: None. P.A. Crisologo: None. L.A. Lavery: Consultant; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Medline Industries, Inc. Research Support; Self; Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Osiris Therapeutics, Inc.