Peripheral arterial disease increases the risk of multidrug-resistant bacteria and amputation in diabetic foot infections

Pınar Aysert Yildiz,Kenan Hizel,Tuğba Özdi̇l,Murat Di̇zbay,Özlem Güzel Tunçcan

doi:10.3906/sag-1803-217

Abstract

The aim of this study was to investigate the microbiological profile and resistance rates of diabetic foot infections (DFIs) and to determine the effect of peripheral arterial disease (PAD) on the microbiology, clinical condition, and treatment outcomes. Characteristics, laboratory and imaging data, and the treatment modalities of patients admitted to our hospital with a diagnosis of DFI (PEDIS classification 3–4) during 2005–2016 were analyzed according to the presence of PAD. Of 112 patients who were included in this study, 86 (76.8%) had PAD. Patients with PAD were older and had higher amputation rates (P < 0.05). A microbiological profile of patients revealed a predominance of gram-positive bacteria (57.1%). Staphylococcus aureus and Streptococcus spp. were the most frequently encountered bacteria. Incidence of Pseudomonas spp. infection was higher in the PAD group (P < 0.05). Of all patients, 24.1% had multidrug-resistant (MDR) microorganisms in their wound cultures. Presence of MDR bacteria in patients with PAD was 4.9-fold higher than that in patients without PAD (P < 0.05). This retrospective study indicates that PAD has a significant role, especially in elderly patients with DFIs. Patients should be promptly evaluated and treated for PAD to prevent infections with resistant microorganisms and limb loss.

Highlights

One-fourth of diabetic patients experience lower extremity infections in their lifetime, and 15%–20% of these infections result in amputation [1,2]
Incidence of Pseudomonas spp. infection was higher in the peripheral arterial disease (PAD) group (P < 0.05)
Presence of MDR bacteria in patients with PAD was 4.9-fold higher than that in patients without PAD (P < 0.05). This retrospective study indicates that PAD has a significant role, especially in elderly patients with Diabetic foot infections (DFIs)

Summary

Introduction

One-fourth of diabetic patients experience lower extremity infections in their lifetime, and 15%–20% of these infections result in amputation [1,2]. Diabetic foot infections (DFIs) are the most common complication in diabetic patients, which lead to hospitalization [3]. The major risk factors for the development of DFIs include peripheral arterial disease (PAD), neuropathy, and poor glycemic control [4]. PAD, defined as an occlusion of the lower extremity arteries, has a special place among these risk factors [5]. In diabetic patients with PAD, changes in the peripheral vascular bed lead to hypoxia in the tissue and cause decreased antibiotic concentrations at the infection site. The wound healing process is impaired, treatment becomes more difficult, and the rates of amputation and mortality increase [4,6,7]

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