An evaluation of risk factors affecting amputation in patients with diabetic foot Infection

Abstract

Introduction: Diabetic foot infections are one of the most common complications of diabetes and generally result in lower extremity amputations. Aim: The purpose of this study is to investigate risk factors affecting amputation in patients diagnosed with diabetic foot ulcer. Materials and Methods: This prospective cohort study involved 137 patients diagnosed with diabetic foot infection in a university hospital 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±6.2 years. 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 Infectious Diseases Society of America classification, moderate foot ulcers were present in 60.6% of patients, mild ulcers 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 amputation 2.7-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 antibiogram results 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 patients with diabetic foot ulcers.