Adverse outcomes in people with swimming pool associated diabetic foot infection: a case series

Abstract

AbstractExercise through swimming is beneficial for patients with diabetes; however, swimming pool environments are known to favour infection. There is at present no available literature on outcomes of swimming pool associated diabetic foot infections and we describe a novel case series of patients who presented with foot infections after using a swimming pool.Individuals attending our Diabetes Limb Salvage Clinic with foot ulcers/infections who had an injury or infection after exposure to a swimming pool environment were identified. We noted ulcer characteristics, pathogens, length of hospital stay and clinical outcomes.Seven individuals (six male, one female, aged 36–68 years) were exposed to a swimming pool environment while on holiday, and within 48 hours had a new ulcer or worsening of their pre‐existing ulcers. Five had new ulcers (two injured their feet on the swimming pool floor, three developed blisters after swimming); two had worsening of their pre‐existing foot ulcers. All patients required hospitalisation (5–20 days) at presentation with severe foot infection. Microbiology showed six patients had mixed flora isolated from their ulcers: Staphylococcus aureus (three), Corynebacterium (two), enteric flora (two), Pseudomonas (one), Streptococcus group C‐G (one) and Bacteroides (one). In terms of outcomes: one patient had a below knee amputation; two required minor amputations.People with diabetes who sustain a foot injury in a swimming pool environment may develop complex infections with waterborne organisms that can be difficult to eradicate, resulting in considerable morbidity including amputation. These risks need to be highlighted and individuals with diabetes advised to protect their feet in water. Copyright © 2021 John Wiley & Sons.