Influence of secondary infection on amputation in chronic critical limb ischemia.
OBJECTIVE
To evaluate the influence of secondary infection on major amputation in chronic critical leg ischemia (CLI).


METHODS
Prospective, controlled observational study.


METHODS
Sixty-seven patients with CLI and ischemic lesions participated in the study. Presence of infection was defined by clinical, laboratory and radiological criteria. Patients were categorized as having no local infection, soft tissue infection or osteomyelitis treated without antibiotics, amoxicillin/clavulanacid for 1 month or ciprofloxacin and clindamycin for 3 months, respectively. Clinical outcome was assessed at 2, 6 and 12 months. Study endpoints were major amputation and mortality. Analyses were performed using the Kaplan-Meier method.


RESULTS
Forty-seven of 67 patients had a local infection. Major amputation was lower in patients with successful revascularization as compared to patients unsuitable for or with failed (without) revascularization (0% vs 26%, p<0.01). In patients with successful revascularization the probability of complete healing was lower with secondary infection (23% vs 71%, p=0.03). In patients without revascularization complete healing was rare (<10%), but secondary infection did not influenced major amputation, mortality or serious adverse events.


CONCLUSIONS
Secondary infection reduces the likelihood of successful healing following revascularisation of CLI.
Jaccard
Y
Y
Swiss Cardiovascular Center, Division of Angiology, University Hospital, Bern, Switzerland.
Walther
S
S
Anderson
S
S
Tauber
M
M
Kummer
O
O
Baumgartner
R
R
Diehm
N
N
Dörffler-Melly
J
J
Baumgartner
I
I
D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications* / Q000188:drug therapy; D007511:Ischemia / Q000150:complications* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014945:Wound Healing
D000900:Anti-Bacterial Agents