Does infection affect amputation rate in chronic critical leg ischemia?
BACKGROUND
Aim was to analyze the association between local infection and amputation rate in patients with chronic critical limb ischemia (CLI) with or without successful revascularization.


METHODS
We performed a retrospective analysis of 56 consecutive patients with 57 critically ischemic legs seen at the University Hospital Bern. Patients with CLI were selected if ischemic lesions and follow-up of more than 2 months were documented. Infection was suggested when 2 of the following criterion were present: temperature > 37 degrees C, C-reactive protein > 50 mg/L, leukocytes > 10 x 10(3)/microliter ("2 of 3" criterion), or a putrid secretion was documented ("secretion" criterion).


RESULTS
In patients with successful revascularization (n = 39), there was a significant shift from 10.3% major to 33.3% minor amputations (Chi Square p value = 0.014) as compared to patients without or with failed revascularization (n = 18) with 44.4% and 11.1% (Chi Square p value = 0.008), respectively. An infection was suggested in 22 of 53 limbs (41.5%) according to the "2 of 3" criterion, and 30 of 57 limbs (52.6%) satisfying the "secretion" criterion. Both criteria, were significantly more common in patients undergoing amputation as compared to patients without amputation (p = 0.001). Multiple lesions were more common in patients with major amputations (p = 0.026).


CONCLUSIONS
Successful revascularization effectively reduces major amputations and leads to healing of ischemic ulcers. Secondary foot infections are frequent. Infections are associated with a significantly higher rate of minor and major amputations, also in patients with successful revascularization, and should be treated adequately as well as in time with antibiotics.
Kummer
O
O
Swiss Cardiovascular Center Bern, Division of Angiology and Division of Cardiovascular Surgery, University Hospital, Bern, Switzerland.
Widmer
M K
MK
Plüss
S
S
Willenberg
T
T
Vögele
J
J
Mahler
F
F
Baumgartner
I
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000601:surgery; D007871:Leg Ulcer / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D016896:Treatment Outcome