title: Clinical characteristics and outcome in 223 diabetic patients with deep foot infections.
abstract: Clinical characteristics and outcome in 223 consecutive diabetic patients with deep foot infections are reported. Patients were treated by a multidisciplinary diabetic foot-care team at the University Hospital, Lund, Sweden, and were prospectively followed until healing or death. About 50% of patients lacked clinical signs of infection, such as a body temperature > 37.8 degrees C, a sedimentation rate > 70 mm/hour, and white blood cell count (WBC) > 10 x 10(9)/liter. Eighty-six percent had surgery before healing or death. Thirty-nine percent healed without amputation; 34% healed after a minor and 8% after a major amputation. Sixteen percent were unhealed at death, and 3% were unhealed at the end of the observation period. Of those unhealed at death or follow-up, 4 patients had had a major and 11 a minor amputation. After correction for age and sex, duration of diabetes < 14 years, palpable popliteal pulse, a toe pressure > 45 mmHg, and an ankle pressure > 80 mm Hg, absence of exposed bone and a white blood cell count < 12 x 10(9)/liter were all related to healing without amputation in a logistic regression analysis. We conclude that although only 1 in 10 had a major amputation, nearly all diabetic patients with a deep foot infection needed surgery and more than one third had a minor amputation before healing or death in spite of a well-functioning diabetic foot-care team responsible for all included patients.
authors.affiliation: Department of Orthopedics, University Hospital, Lund, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Eneroth
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
authors.forename: A
authors.initials: A
authors.lastname: Stenström
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D007239:Infections / Q000145:classification / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome