Advertisement

Do SIRS Criteria Predict Clinical Outcomes in Diabetic Skin and Soft Tissue Infections?

      Abstract

      The aim of this study was to assess whether systemic inflammatory response syndrome (SIRS) is correlated with outcomes in diabetic foot infections (DFIs). We retrospectively reviewed 137 diabetic patients admitted to the hospital with Infectious Diseases Society of America moderate and severe DFIs. We used SIRS criteria to define severe infection based on the presence of at least 2 of the following: heart rate >90 bpm, temperature >38°C or <36°C, respiratory rate >20 breaths per minute, and white blood cell count >12,000/mm3 or <4,000/mm3. Patients with severe DFI were significantly younger (median 49.6 versus 53.6 years, p = .04), less often had type 2 diabetes (88.6% versus 98.9%, p = .01), and less often had a history of previous amputation (15.9% versus 40.9%, p < .01). There were no differences in patients with severe infections defined by SIRS versus moderate infections in the need for surgery (47.7% versus 59.1%, p = .27), any amputation (20.5% versus 29.0%, p = .29), leg amputations (6.8% versus 7.5%, p = .88), duration of antibiotics (median ± standard deviation 34.1 ± 46.5 versus 31.9 ± 47.2 days, p = .47), or healing within 1 year (68.2% versus 66.7%, p = 1.00). Length of hospital stay was the only outcome variable that was significantly different in severe infections (median 12.7 ± 11.9 versus 7.8 ± 5.8 days, p = .02). Foot-related readmission was more common in moderate infections (46.2% versus 25.0%, p = .02). In conclusion, SIRS criteria for severe infections in diabetic patients with skin and soft tissue infections were not associated with a difference in outcomes other than longer hospital stay.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Lavery LA
        • Lavery DC
        • Hunt NA
        • La Fontaine J
        • Ndip A
        • Boulton AJ
        Amputations and foot-related hospitalizations disproportionately affect dialysis patients.
        Int Wound J. 2015; 12: 523-526
        • Reiber GE
        • Pecoraro RE
        • Koepsell TD
        Risk factors for amputation in patients with diabetes mellitus. A case-control study.
        Ann Intern Med. 1992; 117: 97-105
        • Lavery LA
        • Armstrong DG
        • Murdoch DP
        • Peters EJ
        • Lipsky BA
        Validation of the Infectious Diseases Society of America's diabetic foot infection classification system.
        Clin Infect Dis. 2007; 44: 562-565
        • Lipsky BA
        • Berendt AR
        • Cornia PB
        • Pile JC
        • Peters EJ
        • Armstrong DG
        • Deery HG
        • Embil JM
        • Joseph WS
        • Karchmer AW
        • Pinzur MS
        • Senneville E
        • Infectious Diseases Society of America
        2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.
        Clin Infect Dis. 2012; 54: e132-e173
        • Wukich DK
        • Hobizal KB
        • Raspovic KM
        • Rosario BL
        SIRS is valid in discriminating between severe and moderate diabetic foot infections.
        Diabetes Care. 2013; 36: 3706-3711
        • Wukich DK
        • Hobizal KB
        • Sambenedetto TL
        • Kirby K
        • Rosario BL
        Outcomes of osteomyelitis in patients hospitalized with diabetic foot infections.
        Foot Ankle Int. 2016; 37: 1285-1291
        • Wukich DK
        • Hobizal KB
        • Brooks MM
        Severity of diabetic foot infection and rate of limb salvage.
        Foot Ankle Int. 2013; 34: 351-358
        • Mutluoglu M
        • Sivrioglu AK
        • Eroglu M
        • Uzun G
        • Turhan V
        • Ay H
        • Lipsky BA
        The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds.
        Scand J Infect Dis. 2013; 45: 497-503
        • Douglas M.
        In the active voice.
        Routledge, Abingdon, UK2011
      1. PsycholoGenie. Understanding the phenomena of cultural bias with examples. Available at: https://psychologenie.com/understanding-cultural-bias-with-examples. Accessed June 27, 2018.

      2. Mills AJ, Durepos G, Wiebe E. Cognitive biases. In: Encyclopedia of case study research, volumes I and II. Sage Publications, Thousand Oaks, CA, 2010.