Advertisement

Clinical Outcomes of Foot Infections in Patients Without Diabetes

Published:February 12, 2020DOI:https://doi.org/10.1053/j.jfas.2019.07.026

      Abstract

      The aim of this study was to report clinical outcomes of moderate and severe foot infections in patients without diabetes. Medical records of 88 nondiabetic patients with foot infections treated at a safety net hospital were retrospectively reviewed. Patients were grouped by the presence of soft-tissue infection (STI) or osteomyelitis (OM). The diagnosis of OM was determined by positive bone culture or histopathology. STIs were defined by negative bone biopsy or negative imaging with magnetic resonance imaging or computed tomography/dual-modality radiolabeled white blood cell single-photon emission computed tomography. Patient outcomes were recorded ≤1 year after admission. Eighty-eight nondiabetic patients admitted to our institution for moderate or severe foot infections were included, 45 OM and 43 STI. No differences were noted in patient characteristics except that OM patients had a higher prevalence of neuropathy (66.7% versus 39.5%, p = .02). OM patients required surgery more often (97.8% versus 67.4%, p < .01), a greater number of surgeries (2.0 ± 1.2 versus 1.4 ± 1.3, p = .02), and more amputations (75.6% versus 11.6%, p < .01) than STI patients. OM patients had a higher proportion of wounds that healed (82.2% versus 62.8%, p = .04). There were no significant differences in reinfection (35.6% versus 25.6%, p = .36), foot-related readmission to hospital (35.6% versus 23.3%, p = .25), or total duration of antibiotics (13.9 ± 10.2 versus 13.5 ± 12.9, p = .87) between OM and STI patients. In conclusion, OM patients required more surgeries and amputations than patients with STIs; however, they had similar rates of reinfection and readmission within a year after the index hospitalization.

      Level of Clinical Evidence

      Keywords

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

      References

        • Bristow I.
        Foot ulceration in a non-diabetic population: a cross-sectional audit of staff in one health district.
        J Wound Care. 2008; 17: 445-448
        • Haji Zaine N
        • Hitos K
        • Vicaretti M
        • Fletcher JP
        • Begg L
        • Burns J
        Characteristics of non-diabetic foot ulcers in Western Sydney, Australia.
        J Foot Ankle Res. 2016; 9: 6
        • 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
        Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.
        Clin Infect Dis. 2012; 54: e132-s173
        • American Diabetes Association.
        2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2018.
        Diabetes Care. 2018; 41: S13-S27
        • Lipsky BA
        • Aragon-Sanchez J
        • Diggle M
        • Embil J
        • Kono S
        • Lavery L
        • Senneville E
        • Urbancic-Rovan V
        • Van Asten S
        • Peters EJ
        • International Working Group on the Diabetic Foot
        IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes.
        Diabetes Metab Res Rev. 2016; 32: 45-74
        • Lauri C
        • Tamminga M
        • Glaudemans A
        • Juarez Orozco LE
        • Erba PA
        • Jutte PC
        • Lipsky BA
        • MJ IJ
        • Signore A
        • Slart R
        Detection of osteomyelitis in the diabetic foot by imaging techniques: a systematic review and meta-analysis comparing MRI, white blood cell scintigraphy, and FDG-PET.
        Diabetes Care. 2017; 40: 1111-1120
        • Przybylski MM
        • Holloway S
        • Vyce SD
        • Obando A
        Diagnosing osteomyelitis in the diabetic foot: a pilot study to examine the sensitivity and specificity of Tc(99m) white blood cell-labelled single photon emission computed tomography/computed tomography.
        Int Wound J. 2016; 13: 382-389
        • Butalia S
        • Palda VA
        • Sargeant RJ
        • Detsky AS
        • Mourad O
        Does this patient with diabetes have osteomyelitis of the lower extremity?.
        JAMA. 2008; 299: 806-813
        • Jiang N
        • Ma YF
        • Jiang Y
        • Zhao XQ
        • Xie GP
        • Hu YJ
        • Qin CH
        • Yu B
        Clinical characteristics and treatment of extremity chronic osteomyelitis in southern China: a retrospective analysis of 394 consecutive patients.
        Medicine. 2015; 94: e1874
        • Kaminski M
        • Frescos N
        • Tucker S
        Prevalence of risk factors for foot ulceration in patients with end-stage renal disease on haemodialysis.
        Intern Med J. 2012; 42: e120-e128
        • Kremers HM
        • Nwojo ME
        • Ransom JE
        • Wood-Wentz CM
        • Melton 3rd, LJ
        • Huddleston 3rd, PM
        Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009.
        J Bone Joint Surg Am. 2015; 97: 837-845
        • Lavery LA
        • Walker SC
        • Harkless LB
        • Felder-Johnson K
        Infected puncture wounds in diabetic and nondiabetic adults.
        Diabetes Care. 1995; 18: 1588-1591
        • Lavery LA
        • Harkless LB
        • Ashry HR
        • Felder-Johnson K
        Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis.
        J Foot Ankle Surg. 1994; 33: 561-566
        • 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
        • Farhad K
        • Traub R
        • Ruzhansky KM
        • Brannagan 3rd, TH
        Causes of neuropathy in patients referred as “idiopathic neuropathy”.
        Muscle Nerve. 2016; 53: 856-861
        • Hanewinckel R
        • van Oijen M
        • Ikram MA
        • van Doorn PA
        The epidemiology and risk factors of chronic polyneuropathy.
        Eur J Epidemiol. 2016; 31: 5-20
        • Chadayammuri V
        • Herbert B
        • Hao J
        • Mavrogenis A
        • Quispe JC
        • Kim JW
        • Young H
        • Hake M
        • Mauffrey C
        Diagnostic accuracy of various modalities relative to open bone biopsy for detection of long bone posttraumatic osteomyelitis.
        Eur J Orthop Surg Traumatol. 2017; 27: 871-875
        • Kim CJ
        • Kang SJ
        • Yoon D
        • Lee MJ
        • Kim M
        • Song KH
        • Jang HC
        • Jung SI
        • Kim ES
        • Kim HB
        • Oh MD
        • Park KH
        • Kim NJ
        Factors influencing culture positivity in pyogenic vertebral osteomyelitis patients with prior antibiotic exposure.
        Antimicrob Agents Chemother. 2015; 59: 2470-2473
        • Marschall J
        • Bhavan KP
        • Olsen MA
        • Fraser VJ
        • Wright NM
        • Warren DK
        The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis.
        Clin Infect Dis. 2011; 52: 867-872
        • Meyr AJ
        • Singh S
        • Zhang X
        • Khilko N
        • Mukherjee A
        • Sheridan MJ
        • Khurana JS
        Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis.
        J Foot Ankle Surg. 2011; 50: 663-667
        • Castillo RC
        • Mackenzie EJ
        • Bosse MJ
        • Group LS
        Orthopaedic trauma clinical research: is 2-year follow-up necessary? Results from a longitudinal study of severe lower extremity trauma.
        J Trauma. 2011; 71: 1726-1731
        • Starman JS
        • Castillo RC
        • Bosse MJ
        • MacKenzie EJ
        • Group LS
        Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years.
        Clin Orthop Relat Res. 2010; 468: 1669-1675
        • Lam K
        • van Asten SA
        • Nguyen T
        • La Fontaine J
        • Lavery LA
        Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review.
        Clin Infect Dis. 2016; 63: 944-948
        • La Fontaine J
        • Bhavan K
        • Lam K
        • Van Asten S
        • Erdman W
        • Lavery LA
        • Oz OK
        Comparison between Tc-99m WBC SPECT/CT and MRI for the diagnosis of biopsy-proven diabetic foot osteomyelitis.
        Wounds. 2016; 28: 271-278
        • Aslangul E
        • M'Bemba J
        • Caillat-Vigneron N
        • Coignard S
        • Larger E
        • Boitard C
        • Lipsky BA
        Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture.
        Diabetes Care. 2013; 36: 2203-2210