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Invasive systemic infection associated with increased mortality in diabetic foot ulcer
Invasive systemic infection is a major complication of diabetic foot ulcers and is associated with increased mortality, according to data from a retrospective cohort study.
Researchers recommend further study of diabetic foot ulcer-related invasive systemic infections and prioritizing ulcer treatment for patients with diabetes.
“Foot ulcers are a common problem and a source of morbidity for patients with diabetes mellitus,” Shey-Ying Chen, MD, of the division of infectious diseases, department of medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues wrote. “Among diabetic patients 1% to 4% will develop foot ulcers annually and 25% will have foot ulcer during their lifetime. Studies have proposed that diabetic foot ulcers were the portal of entry for Staphylococcus aureus causing endocarditis and complicated spondylodiscitis. We hypothesize that diabetic patients who are discharged from the hospital with an open diabetic foot ulcer are vulnerable to invasive systemic infections arising from these ulcers and their bacterial flora. The burden of diabetic foot ulcers on patients and the health care system will be underestimated without understanding diabetic foot ulcer-associated invasive systemic infection.”
Chen and colleagues studied 819 patients with diabetes who were hospitalized at Beth Israel Deaconess Medical Center in Boston between Jan. 1, 2002 and Dec. 31, 2010 with 1,212 diabetic foot ulcers. The researchers collected patient data including sex, age, comorbidities, severity of infection, diabetic foot medical history, culture results and wound status at the time of hospital discharge.
One hundred forty-one patients had 172 diabetic foot ulcer-invasive systemic infections. Sixty-four percent were bacteremia, 10% were pneumonia, 13% were deep abscesses, 6% were skeletal infections and 7% were endocarditis, the researchers reported. MRSA caused 57% of infections.
Chen and colleagues reported that patients whose cultures showed MRSA infection had high all-cause mortality (13%) and a high 24-month probability of invasive systemic infection (31%). Cox regression modeling showed that invasive systemic infections were predicted by complicated ulcer healing (HR = 3.812; 95% CI, 2.434-5.971) and cultures showing MRSA (HR = 2.03; 95% CI, 1.452-2.838). Diabetic foot ulcer-invasive systemic infections were also associated with higher mortality (HR = 1.987; 95% CI, 1.106-3.568).
“In summary, our study data demonstrate the increased morbidity, burden of care and mortality associated with diabetic foot ulcer-invasive systemic infections as well as the independent risk factors for diabetic foot ulcer-invasive systemic infections. They suggest reduction in diabetic foot ulcer-invasive systemic infections and associated endpoints for controlled trials examining MRSA eradication plus strategies to promote earlier diabetic foot ulcer healing,” the researchers wrote. “Strategies to eradicate MRSA when present and to facilitate rapid ulcer healing, such as aggressive surgical debridement, early attention to enhancement of arterial supply and techniques to accelerate wound closure should be considered.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.