title: A prospective, multi-center study: factors related to the management of diabetic foot infections.
abstract: The Turkish Association of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Working Group conducted a prospective study to determine the factors affecting the outcomes of diabetic foot infections. A total of 96 patients were enrolled in the study. Microbiological assessment was performed in 86 patients. A total of 115 causative bacteria were isolated from 71 patients. The most frequently isolated bacterial species was Pseudomonas aeruginosa (n = 21, 18.3%). Among cases with bacterial growth, 37 patients (43%) were infected with 38 (33%) antibiotic-resistant bacteria. The mean (±SD) antibiotics cost was 2,220.42 (±994.59) USD in cases infected with resistant bacteria, while it was 1,206.60 (±1,160.6) USD in patients infected with susceptible bacteria (p < 0.001). According to the logistic regression analysis, the risk factors related to the growth of resistant bacteria were previous amputation (p = 0.018, OR = 7.229) and antibiotics administration within the last 30 days (p = 0.032, OR = 3.796); that related to the development of osteomyelitis was wound size >4.5 cm(2) (p = 0.041, OR = 2.8); and that related to the failure of the treatment was the growth of resistant bacteria (p = 0.016, OR = 5.333). Diabetic foot osteomyelitis is usually a chronic infection and requires surgical therapy. Amputation is the accepted form of treatment for osteomyelitis. Limited limb-saving surgery and prolonged antibiotic therapy directed toward the definitive causative bacteria are most appropriate. This may decrease limb loss through amputations. As a result the infections caused by resistant bacteria may lead to a high cost of antibiotherapy, prolonged hospitalization duration, and failure of the treatment.
authors.affiliation: School of Medicine, Department of Infectious Diseases and Clinical Microbiology, University of Adnan Menderes, 09100, Aydin, Turkey. bertugrul@adu.edu.tr
authors.forename: B M
authors.initials: BM
authors.lastname: Ertugrul
authors.forename: O
authors.initials: O
authors.lastname: Oncul
authors.forename: N
authors.initials: N
authors.lastname: Tulek
authors.forename: A
authors.initials: A
authors.lastname: Willke
authors.forename: S
authors.initials: S
authors.lastname: Sacar
authors.forename: O G
authors.initials: OG
authors.lastname: Tunccan
authors.forename: E
authors.initials: E
authors.lastname: Yilmaz
authors.forename: O
authors.initials: O
authors.lastname: Kaya
authors.forename: B
authors.initials: B
authors.lastname: Ozturk
authors.forename: O
authors.initials: O
authors.lastname: Turhan
authors.forename: N
authors.initials: N
authors.lastname: Yapar
authors.forename: M
authors.initials: M
authors.lastname: Ture
authors.forename: F
authors.initials: F
authors.lastname: Akin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy*; D017719:Diabetic Foot / Q000150:complications*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents