Diabetic Foot Patients Research Articles

A Study on Clinical Profile of Patients with Diabetic Foot

Diabetes is a worldwide problem. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. A significant number of such patients will require long-term hospital treatment and amputations. The etiopathogenesis of diabetic foot lesions are multifactorial. This study was conducted comprising of 100 patients of Diabetic foot in the Department of Surgery at Medical College. All the patients with Diabetes Mellitus presenting with foot ulcers, infection of foot and gangrene of foot. Incidence of Ulcer was common in patients with 6-10yrs of diabetes (36.53%), followed by 2-5 yrs group (26.92%). Gangrene was found more in 11-15 yrs group (30.43%), while incidence of abscess was relatively same among all groups, while incidence of cellulitis was common among 6-10 yrs group.

Detection of Capsular Polysaccharide Virulence Genes rmpA and magA of Klebsiella Pneumonia Isolate from Diabetic Foot Ulcer Patient in Najaf Governorate in Iraq

Klebsiella Pneumoniae is an opportunistic pathogen, which mostly cause nosocomial infections. K.Pneumoniae utilizes a variety of virulence factors, especially capsule polysaccharide, lipopolysaccharide,fimbriae, outer membrane proteins and determinants for iron acquisition and nitrogen source utilization,for survival and immune evasion during infection. A total of (36) clinical swab specimens isolated frompatient with diabetic foot ulcer in Al-Sdder Medical City (Central Diabetic Foot) in Najaf Governorate,Iraq from November 2019 to February 2020 , for detection some virulence capsular polysaccharide genessuch as rmpA and magA that related with K1 serotype of K . pneumonia and associated with antibioticresistance pattern in patient of diabetic foot ulcer. Antibiotic susceptibility test of K. Pneumoniae isolatesagainst (20) of commonly used antibiotic showed there 25 (69%) of K. pneumonia isolate from diabeticfoot patient were Multi-drug resistance (MDR),while11(31%) were extensive-drug resistance (XDR). Theresults of amplified product demonstrated that K1 serotype of K . Pneumonia was positive in 23 (64%)of totally clinical specimen than other types of serotype ( Non-K1 serotype). (magA) gene that associatedwith hypermucoid viscosity was positive in 21 (58%) of total specimens while (rmpA) gene that regulate ofcapsular polysaccharide of K .pneumonia was positive in 22 (62%) of totally samples

Nomogram Model for Predicting the Risk of Multidrug-Resistant Bacteria Infection in Diabetic Foot Patients.

ObjectiveThis study established an individualized nomogram for predicting the risk of multidrug-resistant bacterial (MDRB) infection in patients with the diabetic foot (DF), and providing a reference for clinical prevention and treatment.MethodsA total of 199 DF patients admitted to the hospital from July 2015 to December 2018 were included in this study. The pathogenic bacteria at the site of infection were detected and the factors affecting the occurrence of MDRB infection in DF patients summarized. The R software was used to draw the nomogram, and the Bootstrap Method used to internally verify the model. The calibration curve and the Harrell’s Concordance Index (C-index) were used to evaluate the predictive effect of the nomogram model.ResultsLogistic regression analysis showed that age, course of diabetes, previous use of antibacterial drugs, types of antibacterial drugs, and osteoporosis were risk factors for multidrug-resistant infections in DF (P<0.05). The area under the receiver operating characteristic curve (AUC, Area Under Curve) of the nomogram model after internal verification was 0.773 (95% CI: 0.704–0.830). The mean absolute error between the predicted probability of infection in the nomogram and the actual occurrence of MDRB was 0.032, indicating that the nomogram model had good forecasting efficiency and stability.ConclusionThe risk factors for multidrug-resistant infections in DF are age, course of diabetes, previous use of antibacterial drugs, types of antibacterial drugs used, and osteoporosis. The nomogram model drawn on these risk factors has good predictive accuracy and can assist medical staff in formulating targeted infection prevention strategies for patients.

Consulta de enfermagem como espaço educativo para o autocuidado do paciente com pé diabético

Objetivos: Realizar uma ação educativa para o autocuidado do paciente com pé diabético e avaliar o conhecimento apreendido. Método: A ação educativa ocorreu no Ambulatório de Feridas e Pé Diabético, no interior do estado de São Paulo, em pacientes com pé diabético. Durante a consulta de enfermagem, foi realizada uma ação educativa para as práticas de autocuidado com os pés. No fim, aplicou-se um questionário para avaliar o conhecimento apreendido. Foi utilizada a estatística descritiva. Resultados: A amostra foi composta de 42 pacientes, sendo 54,8% do sexo masculino, com média de idade de 63,0 (±13) anos. Do total, 80,3% tinha diagnóstico de diabetes mellitus (DM) havia mais de 10 anos, e o pé diabético (100%), a retinopatia (47,4%) e a cardiopatia (34,2%) foram as complicações mais frequentes. A maioria compreendeu que a alimentação saudável (85,7%) e o exercício físico (100%) são necessários para manter o nível glicêmico controlado. Em relação ao autocuidado com os pés, 80,9% dos pesquisados inspecionam os pés diariamente, 95,2% os lavam com água fria para morna, 7,2% relataram dúvidas quanto à hidratação, 4,8% faziam o corte arredondado das unhas, 14,3% retiravam a cutícula na manicure, 16,7% utilizavam sandálias, e 9,5% calçavam tipos de meia inadequados. Conclusão: Acredita-se que as contribuições deste estudo estejam no desafio de sensibilizar a população para a adoção de hábitos saudáveis e para a implementação de práticas educativas direcionadas ao encorajamento do autocuidado.

I fear COVID but diabetic foot (DF) is worse: a survey on patients' perception of a telemedicine service for DF during lockdown.

AimsTo evaluate the patients’ perceptions of telemedicine visits during COVID-19 lockdown and their level of anxiety about COVID and diabetic foot (DF).MethodsIn May 2020, we contacted by phone all the patients who underwent in March and April to remote monitoring visits for DF during the lockdown for COVID-19, with a structured interview, focusing on their perceptions about telemedicine service for DF and on the anxiety toward COVID and DF.ResultsWe analyzed 257 remote monitoring visits in 211 patients. Two hundred and six patients answered the follow-up interview; 177 patients (85.9%) remembered the monitoring visit, 140 (67.9%) the health care professional and 181 patients (87.9%) the reason of contact; 169 patients were alone during the visit, 37 with a relative. Patients judged useful both the monitoring during pandemic (4.35 ± 0.28 on a maximum of five) and the possibility to continue after the lockdown (4.34 ± 0.23 on a maximum of five). Eventually, we observed that DF patients were more worried by DF than by COVID on a scale from 0 (not fear at all) to 5 (terrified) (4.79 ± 0.05 vs. 3.27 ± 1.03, p < 0.05). This difference was higher in previously ulcerated patients (4.84 ± 0.03 vs. 3.03 ± 1.13, p < 0.05) and even more in amputees (4.93 ± 0.03 vs. 2.73 ± 1.21, p < 0.05).ConclusionsDF patients appreciated televisits during lockdown and the continuation of this service after its end. In this context DF prevails on COVID in the worries of patients, especially if they are recurrent ones.

Nomogram analysis of the influencing factors of diabetic foot in patients with diabetes mellitus.

To explore the influencing factors of diabetic foot (DF) in diabetic patients and evaluate the influencing factors. All 674 diabetic patients admitted to our hospital from January 2015 to June 2019 who met the research criteria were included as study subjects. Clinical data were collected retrospectively by filling in the case report form for clinical research, including the general demographic characteristics, disease history, laboratory examination results, and incidence of diabetes-related complications. Logistic regression analysis was used to screen the factors influencing DF: the nomogram method was applied to score the factors, and a scoring model was constructed. A total of 122 patients (18.1%) with newly diagnosed DF were identified. Multivariate analysis showed that long duration of diabetes (OR = 2.355), complicated diabetic nephropathy (OR = 3.073), and high HbA1c levels (OR = 1.885) were risk factors for DF development and that foot care education (OR = 0.473) was a protective factor. Cox proportional risk model analysis showed that, compared to patients with better control of HbA1C, the hazard ratio (HR) of DF in the HbA1 group, HbA2 group, and HbA3 group was 1.25, 1.58, and 4.71, respectively. Nomogram model analysis showed that the total score of each factor ranged from 44 to 176 points, and the corresponding risk rate ranged from 0.10 to 0.90 points. The higher the total score, the greater the risk of DF in diabetic patients; the area under the curve in the nomogram model was 0.742; 95% CI: 0.665~0.820 (P < 0.0001). The key to preventing DF is to enhance diabetic patients' education regarding DF care, improve patients' self-management abilities, and improve patients' blood glucose control.

A STUDY OF 50 CASES OF DIABETIC FOOT AT TERTIARY CARE HOSPITAL

BACKGROUND AND OBJECTIVES :- The present study was attempted to nd out the role of conventional and newer modalities for the treatment and rehabilitation and prevention of complication of diabetic foot patients. MATERIALAND METHOD:-. 50 patients of diabetic foot admitted in civil Hospital,ahmedabad were studied within two years from 2018 to 2020 and careful assessment of history, clinical ndings, investigation, management and follow-up of these patients done. RESULT:-According to my study, Diabetic foot is common in males &amp; 51-60 years of age group,in smokers, in lower socio-economic class, with average duration of 8 to 10 years of diabetes melitus, most common type of lesion was abscess,most common site was forefoot, mostly was of neuropathic in nature &amp; mostly managed by debridement. Mean hospital stay was 1 week to 1 month. CONCLUSION:- Patient education and awareness regarding good sugar control of diabetes, use of proper antibiotics, adequate debridement and proper dressing ;with eusol, betadine hydrogen peroxide along with newer dressing methods like vacuum dressing found to be effective. Amputation done only for gangrene and proper rehabilitation method carried out for these patients.

Factors associated with the risk of diabetic foot in patients with diabetes mellitus in Primary Care.

To analyze factors associated with diabetic foot risk in patients with diabetes mellitus assisted in Primary Care. Observational, analytic, and transversal study took place in Teresina, Piauí, with diabetic patients who are assisted in Primary Care. Data collection took place through interviews, foot clinical exams, and medical record analysis. We used the Mann-Whitney, Pearson's Chi-square and multiple logistic regression statistics tests to analyze the data. The association power among categorical variables was measured by Odds Ratio . 322 patients participated. Marital status with a partner presented a protection factor (p = 0.007). Risk factors for the development of the diabetic foot are: arterial hypertension (p = 0.045), obesity (p = 0.011), smoking (p = 0.027), not being submitted to follow ups (p = 0.046), inadequate control of capillary blood glucose (p < 0.001), indisposition to the care of the foot (p=0.014), and foot self-exam less frequently (p = 0.040). Sociodemographic, clinical, and self-care aspects interfere in diabetic foot development, highlighting the necessity of effective follow up tracking and educational interventions for patients with diabetes mellitus in Primary Care.

Assessment of diabetic foot risk among diabetic patients in a tertiary care hospital, South India.

INTRODUCTION:Foot problems are most common among patients with diabetes, and they are an important cause of morbidity in patients with diabetes mellitus (DM). They can be prevented by following a simple foot care practice. The study objective was to stratify the level of risk for diabetic foot ulcer (DFU) among patients with diabetes by screening.MATERIALS And METHODS:A descriptive cross-sectional study design was adopted in this study. The sample size was 196, and a standardized INLOW'S 60-s diabetic foot screening tool was used to assess the risk of diabetic foot. Data collection was done by face-to-face interview, and diabetic foot risk (DFR) was assessed by direct observation, inspection, and palpation methods.RESULTS:Among the 196 patients, majority required yearly foot screen in both feet. The mean and standard deviation of the level of DFR in the left foot (LF) and right foot (RF) was 4.31 ± 2.267 and 4.51 ± 2.391, respectively. There was a statistically significant association between the practice of treatment and level of foot screening recommendation in the LF with Chi-square value of χ2= 8.20 (df = 2) and RF with Chi-square value of χ2= 7.95 (df = 2) at P < 0.05 level.CONCLUSION:Health-care providers should be made aware of the regular practice of screening the foot of diabetic patients along with health education awareness programs. It may be helpful to identify the foot ulcer risk at an early stage. It will prevent further complications of DFU and recurrence of ulcer and will reduce the economic burden to patients and their family members and the health-care system.

Triple assessment for addressing trio-pathy in diabetic foot – Rapid screening tool for amputation prevention in govt. Hospital setting

Introduction: The present study was done to perform foot examination using Amit Jain’s Triple Assessment screening tool on in-patients in surgical wards. Materials and Methods: A descriptive retrospective study was done at Gajra Raja Medical College, Gwalior (M.P.) in department of surgery during a period from April 2018 to June 2018 on patients of diabetic foot admitted in all six units of surgical wards. Results: A total of 72 patients were included in this study as per search in case records. Majority of patients had diabetes of more than ten years duration and males were more commonly affected. All patients had diagnosis of diabetic foot with varied spectrum of associated lesions alone or in combination. Surgical debridement (66.66%) was the commonest procedure done in these patients. The affected foot of all patients was examined, with component assessment of feeling pedal pulses done in 86.11% cases and testing for sensation was done in 25% cases. In contralateral foot 58% patients were examined, in similar percentage pedal pulses were examined and foot sensations were not tested in any of them. Conclusion: Despite foot examination being of paramount importance it is often incomplete and inadequate in diabetic foot subjects as is also evident from observations of present study. Amit Jain’s Triple assessment of diabetic feet is a rapid inexpensive screening tool for obtaining basic foot information in order to segregate at risk feet and offer preventive care against amputation. Keywords: Amit Jain, Assessment, Triple, Diabetic foot, Trio-pathy, Screening, High risk foot.

Missed diagnosis and delayed treatment of acromegaly in a patient with severe diabetes: A case report.

The early stages of acromegaly are characterized by slow and progressive acral overgrowth without major systemic complications. Failure to diagnose acromegaly at an early stage may have devastating consequences on patient care. The case in the present report was a 44-year-old Japanese man, referred to Kuwana City Medical Center due to severe hyperglycemia detected in a general checkup. The patient had no acromegaly-related complaints. Laboratory data revealed high blood levels of hemoglobin A1c and glucose. Careful physical examination revealed enlargement of extremities and soft tissues. Laboratory investigation indicated a high blood concentration of growth hormone, and magnetic resonance imaging disclosed an enhanced pituitary tumor. The diagnosis was pituitary tumor-associated acromegaly with severe diabetic complications. The pituitary tumor became large and unresectable following 10 years of misdiagnosis. The patient was treated with somatostatin receptor ligands (lanreotide and pasireotide), as well as bromocriptine in Mie University Hospital. The tumor size was reduced following treatment, though it was still unresectable at the time of this report. The case highlights the importance of hyperglycemia and abnormal manifestations of the feet in patients with acromegaly. In addition, these findings highlight the need for a thorough examination of the feet in diabetic patients, and the critical importance of the early diagnosis of acromegaly for preventing the consequences of inappropriate patient care.

Establishment of a diagnostic model of coronary heart disease for patients with diabetic foot.

This study aims to establish a diagnostic model of coronary heart disease (CHD) for diabetic foot (DF) patients.The clinical data of 489 hospitalized patients with DF were retrospectively analyzed in this case-control study. The patients were divided into the CHD group (DF with CHD, n = 212) and the control group (DF without CHD, n = 277). Univariate analysis was performed to screen for CHD-related risk factors, and multivariate logistic regression analysis was conducted to determine significant CHD risk factors. Scores were assigned according to the ratio of risk factors (OR) to establish a diagnostic model of CHD for patients with DF. The area under the ROC curve was used to test the application value of the diagnostic model.The logistic regression analysis showed that the risk factors for CHD in DF patients were age, duration of diabetes, toe-brachial index, hyperuricemia, and chronic renal insufficiency. The area under the ROC curve of the diagnostic model was 0.798 (0.759–0.837), the diagnostic point of CHD was 6 points, the diagnostic sensitivity was 69.3%, and the specificity was 76.5%.The established model has good diagnostic value and provides the basis for preliminary screening for CHD in patients with DF.

Ankle Brachial Index berhubungan dengan Sensitivitas Kaki Pada Penderita Diabetes Militus Tipe II

ABSTRACT&#x0D; Introduction : Chronic hyperglycemia can cause blood vessel endothelial cells and nerve cells to become hyperglycolic. This condition results changes in various biochemical pathways, one of which is protein kinase C (PKC) which causes thickening of the arteries resulting in decreased ABI values. Decreasing the ABI value will disrupt of Schwann cell metabolism, so that it will cause impaired peripheral nerve delivery. Disruption of peripheral nerve delivery will cause a decrease of foot sensitivity. This study aimed to determine the relationship of ankle brachial index (ABI) with foot sensitivity in patient with diabetes mellitus type II in Public Health Center I of South Denpasar.&#x0D; Method : This study used cross sectional method. The number of samples of this research was 86 people collecting by purposive sampling technique. Data were collected used digital spygmonanometer and monofilament 10 g.&#x0D; Result : As many as 23 people with ABI vascular disorders and 42 people with decrease of foot sensitivity. Chi square test results obtained p = 0,000 with a significance value of p&lt;0.05, so 0.000 &lt;0.05 which shows that there is a relationship between ABI and foot sensitivity in patients with diabetes mellitus type II in Public Health Center I of South Denpasar.&#x0D; Discussion : Decrease of ABI value will following with decrease of foot sensitivity, if this isn’t prevented there is a risk of developing diabetic foot in patients with diabetes mellitus type II.&#x0D;

Treatment Outcome of Diabetic Foot Based on the Control of Random Blood Glucose and HbA1c in BIRDEM General Hospital, Dhaka, Bangladesh

Background: Diabetic foot is a common and potentially disastrous complication that can rapidly progress to irreversible septic gangrene, necessitating foot amputation.&#x0D; Objectives: To assess the clinical outcome of treatment of diabetic foot in diabetic patients based on random blood glucose (RBG) and HbA1c level.&#x0D; Materials and method: This prospective observational study was conducted in the Department of Surgery, BIRDEM General Hospital, Shahbag, Dhaka, Bangladesh, from July 2018 to December 2018. A total of 350 patients with diabetic foot were enrolled in the study based on inclusion and exclusion criteria. The patients were divided into four groups based on RBS and HbA1c level. A complete history was taken, thorough clinical examination was done and relevant investigation reports were collected. Collected data were classified, edited, coded, and entered into the computer for statistical analysis using SPSS version 23.&#x0D; Results: Mean age was 47.6±13.3 years in group A, 48.2±12.7 years in group B, 46.7±13.1 years in group C, and 49.9±12.5 years in group D. Male to female ratio was 2.3:1 in group A, 3.5:1 in group B, 1.5:1 in group C and 2.9:1 in group D. One hundred eight patients were found to have Wagner ulcer grading I. Among them, 2(20.0%) were in group A, 9(33.3%) were in group B, 12(36.4%) were in group C, and 85(30.4%) were in group D. Twenty-two patients were found to have Wagner ulcer grading IV. Among them, 1(3.0%) of group C and 21(7.5%) of group D. The difference was statistically significant (p&lt;0.05) among the four groups. Two hundred eighty-eight patients had wound healing time of 2-6 weeks. Among them were 1(10.0%) in group A, 25(92.6%) in group B, 29(87.9%) in group C, and 233(83.2%) in group D. The mean wound healing time was found to be 1.5±0.7 weeks in group A, 3.1±1.3 weeks in group B, 3.6±1.2 weeks in group C and 4.9±1.8 weeks in group D. The difference was statistically significant (p&lt;0.05) among four groups. One hundred six patients underwent amputation at a different level. Among them, 1(10.0%) in group A, 5(18.5%) in group B, 13(39.4%) in group C and 87(31.1%) in group D. The difference were not statistically significant (p&gt;0.05) among four groups.&#x0D; Conclusion: Elevated HbA1c was associated with slower and incomplete foot healing in diabetic patients. Random blood glucose and HbA1c parameters can be used as dependable predictors of foot ulcer healing in the diabetic patients.&#x0D; Delta Med Col J. Jul 2020;8(2): 86-92

Microbial spectrum, antibiotic susceptibility profile, and biofilm formation of diabetic foot infections (2014-18): a retrospective multicenter analysis.

This study identifies the risk factors, microbiological properties, antimicrobial susceptibility patterns, mortality, and clinical complications associated with organisms causing diabetic foot infections (DFIs) with or without antibiotic treatment using data from a retrospective multicenter surveillance. Specimens collected from different hospitals were cultured and the extended-spectrum β-lactamase (ESBL) excretion was estimated. The antibacterial susceptibility pattern and biofilm formation were completed along with the recommended standard methods. Overall, 792 diabetic foot patients (DFPs) were enrolled and a total of 1803 causative organisms were isolated. Polymicrobial infection was identified in 48.5% of the patients. The isolated Gram-positive pathogens (46.7%) were higher than Gram-negative (38.6%) or anaerobes (7.9%). The predominant pathogens were S. aureus (22.2%), methicillin-resistant S. aureus (7.7%), Enterococcus spp. (12.8%), Pseudomonas aeruginosa (9.4%), E. coli (7.9%), Klebsiella spp. (7.5%), Proteus mirabilis (8.9%), coagulase negative staphylococci (CoNS) (6.6%), anaerobic organisms (5.9%), and fungi (2.3%). Vancomycin and clindamycin exhibited no activity against Gram-positive bacteria. However, meropenem and imipenem displayed high activity against the Gram-negative isolates. Out of the 765 tested strains, 251 showed moderate (15.8%) to high (34%) level biofilm-producing phenotype. DFIs were widespread among the diabetic patients with different microbial etiology and the major organisms were aerobic organisms. Our findings may provide an insight into the development of appropriate therapeutic strategies for the management of DFIs.

A Study of Microbial Profile and Drug Resistance Pattern in the Patients with Diabetic Foot at a Tertiary Health Care Center

Introduction: Diabetic Foot Ulcer (DFU) is a serious and common complication of Diabetes Mellitus (DM). India has been called "the diabetes capital of the world.” The most common cause of morbidity and mortality in DFU is infections. Diabetic foot wounds are commonly infected, and infection leads to the formation of microthrombi causing further ischemia, necrosis, and progressive gangrene. These types of situations necessitate limb amputation. Thus, accurate diagnosis of the causative organism is essential for the management of these cases. Aims and Objectives: To Study microbial profile as well as drug resistance pattern in the patients having diabetic foot at a tertiary care center. Methodology: Approval from institutional ethical committee was obtained. 62 patients of diabetic foot were selected for the present study over 1 year. Wound discharge culture and antibiotic sensitivity testing were carried out using standard microbiological procedures. Result: In the study carried out it was observed that the majority of the patients fell under the age group consisting of those &gt;60. The most common organism was Staphylococcus followed by Streptococci, Enterococcus. Gram positive organisms were most commonly sensitive to Vancomycin. Gram negative organisms were susceptible to Piperacillin-Tazobactum. Maximum resistance was found to be for Gentamycin. Conclusion: From the study it can be conclusively noticed that majority patients belonged to the age group consisting of &gt;60 Yrs. Gram positive organisms showed highest sensitivity to Vancomycin. In case of Gram negative organism's antibiotic with highest sensitivity was Piperacillin-Tazobactam. Gentamicin was the drug with highest resistance. This resistance pattern to various pathogens in our study will be helpful in treatment of Diabetic foot in future.

Combined analysis of circRNA and mRNA profiles and interactions in patients with Diabetic Foot and Diabetes Mellitus.

In order to elucidate the pathogenesis and explore new biomarkers for diabetes and diabetic foot (DF), an analysis using RNA sequencing affords broader insights into gene expression regulatory networks in DF. To better explore the molecular basis of DF, we carried out an analysis of circular RNA (circRNA) and messenger RNA (mRNA) expression profiles of serum samples from DF patients and diabetes mellitus (DM) patients. The potential roles and interactions of differentially expressed circRNAs and mRNAs were classified by gene ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses. Compared with diabetes patients, 279 mRNAs were upregulated and 353 mRNAs were downregulated in the serum of DF patients, and 33 circRNAs were differently expressed. The differential genes at the nodes of the interaction network were screened, and TLR6 RUNX1 and ST2 were found to be related to the progression of diabetes and DF. The enrichment pathway analysis revealed that the lysosomal pathway played a critical role in the occurrence and development of DF. TLR6, RUNX1, and ST2 mRNA expressions and the lysosomal pathway may be involved in the pathogenesis of diabetes and DF. In addition, methane metabolism and Chagas disease pathways were observed in the occurrence and development of DF, which is a new discovery in this study. This study provides clues on the molecular mechanisms of DF at the circRNA and mRNA levels.

Pilot Experience on the Use of S53P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis.

To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.

P1044RENAL DIABETIC FOOT: DIFFERENT PATTERNS AND CHARACTERIZATION OF PERIPHERAL ARTERY DISEASE BETWEEN NON-UREMIC AND UREMIC DIABETIC PATIENTS

Abstract Background and Aims The diabetic foot (DF) was traditionally considered a local foot problem due to diabetes; however many observations support the concept that the DF is actually a part of a more complex diabetes related syndrome which includes several long-term complications and co-morbidities. In recent years, an increase in the incidence of ischemic diabetic foot ulcers (DFUs) amongst dialyzed subjects has been observed, going up from approximately 5-10% fifteen years ago to the current rate of approximately 30-35%. Today it is well recognized that end stage renal disease (ESRD) is an independent risk factor for non-healing ulcers and amputation in diabetic subjects. In clinical practice, the presence of foot problems in ESRD diabetic patients is identified as a specific entity termed “renal-diabetic foot”. The aim of this study is to describe the angiographic characteristics of peripheral arterial disease (PAD) in patients with DFUs receiving chronic dialysis treatment. Method The study group was composed of patients with DFUs and PAD who referred to our diabetic foot unit. All patients have been managed with a pre-set limb salvage protocol including revascularization of the affected limb. Arterial lesions (stenosis between 50-99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence of dialytic treatment, patients were divided in two subgroups: renal-diabetic foot (RDF) and diabetic foot (DF). Patterns of PAD and immediate revascularization outcome (technical revascularization outcome) for RDF and DF were separately reported and compared Results The demographic and clinical characteristics were reported in Table 1.RDF reported greater number of affected vessels (n= 5±1.6 vs 3.9±1.5, p&amp;lt;0.0001), greater involvement of the superficial femoral artery (90.2 vs 75.8%, p=0.003), tibial-peroneal trunk (53.7 vs 25.5%, p=0.01), anterior tibial artery (93.9 vs 80.9%, p=0.03) and below-the-ankle arteries (70.7 vs 35.7%, p=0.0001) than DF patients. RDF showed a higher rate of revascularization failure (43.9 vs 15.3%, p&amp;lt;0.0001) in comparison to DF patients (Table 2). Below-the-ankle (BTA) arterial disease [OR 9.5 (CI 95% 3.5-25.4) p=0.0001] resulted as the only independent predictor of revascularization failure. Conclusion It was interesting to highlight that the above mentioned findings could be specifically related to the effect of renal disease on the arteries of the lower extremity because the two groups, RDF and DF, did not report any difference in terms of other traditional cardiovascular risk factors (age, smoke, arterial hypertension, dyslipidemia, diabetes duration) which could influence the characteristics of PAD. RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison to DF subjects. BTA arterial disease is an independent predictor of revascularization failure.

Calculated initial parenteral treatment of bacterial infections: Skin and soft tissue infections.

This is the ninth chapter of the guideline “Calculated Parenteral Initial Therapy of Adult Bacterial Disorders – Update 2018” in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience.The chapter contains the first German S2k guidelines for bacterial skin and soft tissue infections. They encompass recommendations on diagnosis and treatment of the defined entities erysipelas (caused by beta-hämolytic streptococci), limited superficial cellulitis (S. aureus), severe cellulitis, abscess, complicated skin and soft tissue infections, infections of feet in diabetic patients (“diabetic foot”), necrotizing soft tissue infection and bite injuries.