An audit of foot infections in patients with diabetes mellitus following renal transplantation.
Foot lesions in postrenal transplant diabetics are often overlooked and hence underestimated. An audit of patients attending the authors' department was done. They reviewed the case notes to assess the presentation, clinical profiles, and outcomes of foot infections in patients with diabetes mellitus who received renal transplants at their center. Medical records of 192 diabetic foot patients were assessed, of which 8.8% (n = 17) had a history of previous renal transplantation for diabetic nephropathy. All 17 patients had noninsulin-dependent diabetes of mean duration of 16.2 years (range 7-27 years). Common complications and risk factors were studied. Mean duration to development of foot lesions in renal allograft recipients was 19.7 months (range 6-84 months). The big toe was the most common site of infection. Neuropathy and poor foot care appear to be important factors in the development of these foot lesions. Escherichia coli was the predominant organism on pus culture. Thirty-eight percent of patients needed major amputations; absence of an intact distal vascular tree was associated with a high major amputation rate. Two patients expired due to foot-related septicemia, and healing occurred in the remainder. Mean hospitalization time was 32.7 days. Most patients required more than one admission. The study emphasizes the need for greater attention to lower extremity complications in this patient group.
George
Robbie K
RK
Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. robbiekgeorge@yahoo.co.in
Verma
Ashok K
AK
Agarwal
Amit
A
Agarwal
Gaurav
G
Mishra
Saroj K
SK