Diabetic foot infections: effective microorganisms and factors affecting the frequency of osteomyelitis and amputation

Abstract

Objectives. Diabetic foot infections are common reason for hospitalization and are associated with high morbidity and mortality. We aimed to evaluate the clinic features and predisposed causes of osteomyelitis and amputation of patients with diabetic foot infections. Methods. Patients with diabetic foot infections who admitted and hospitalized at Infection Diseases and Clinical Microbiology department between January 2012 and July 2014 were included. Osteomyelitis was evaluated using magnetic resonance imaging (MRI) or bone scintigraphy. Microbiological examinations (Gram staining and culture) of the debridement materials and pus aspiration materials of the lesions were performed. Results. Of the seventy-three diabetic foot infected patients, 37 (50.7%) were female, and 36 (49.3%) were male. The mean age of patients was 57±9.8 years. The mean duration of diabetes and HbA1c level were 13.3±5.3 years and 8.17±1.83%; respectively. Soft tissue infection without osteomyelitis was present in only 34 out of 73 (46.5%) patients. A total of 89 pathogens were identified in 52 patients whereas any microorganism was not identified in 28.7%. Polymicrobial infections were detected in 30 (41%) patients. The most common isolated microorganism was Pseudomonas aeruginosa (36.9%), followed by Staphylococcus aureus (31.5%) and Enterococcus spp. (13.6%). Of the 37 (50.7%) patients had a history of diabetic foot infection previously, osteomyelitis progression was higher (89.2%) and statistically significant in these patients. Twelve (16.4%) patients underwent amputation. Conclusions. Advanced age and presence of osteomyelitis were found as risk factors for amputation. In the presence of osteomyelitis, treatment of diabetic foot infections is difficult and amputation rate is higher. For this reason, diabetic foot infections should be promptly treated before the development of osteomyelitis, and multidisciplinary approach is needed.