title: Does infection affect amputation rate in chronic critical leg ischemia?
abstract: 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.
authors.affiliation: Swiss Cardiovascular Center Bern, Division of Angiology and Division of Cardiovascular Surgery, University Hospital, Bern, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Kummer
authors.forename: M K
authors.initials: MK
authors.lastname: Widmer
authors.forename: S
authors.initials: S
authors.lastname: Plüss
authors.forename: T
authors.initials: T
authors.lastname: Willenberg
authors.forename: J
authors.initials: J
authors.lastname: Vögele
authors.forename: F
authors.initials: F
authors.lastname: Mahler
authors.forename: I
authors.initials: I
authors.lastname: Baumgartner
mesh_terms: 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