title: Severity of diabetic foot infection and rate of limb salvage.
abstract: BACKGROUND
  Foot infections are limb-threatening complications in patients with diabetes mellitus (DM), and proper classification of the severity of diabetic foot infection (DFI) is important in determining an effective antibiotic regimen, the need for hospitalization and surgery, and the risk of amputation. Our hypothesis was that patients with severe DFI would have a longer hospitalization than those with moderate DFI. The purposed of this study was 2-fold. The first purpose was to define DFI using readily available clinical information and objective parameters outlined by consensus statements. The second purpose of this study was to assess rates of amputation and limb salvage for hospitalized patients with DFI.
  
  
  METHODS
  The database of a single academic foot and ankle program was reviewed for patients who were hospitalized for a DFI from 2006 to 2011. Inpatient and outpatient electronic medical records identified 100 patients. Severe DFI was defined as having 2 or more objective findings of systemic toxicity and/or metabolic instability at the time of initial assessment.
  
  
  RESULTS
  The length of stay was significantly shorter for patients with a moderate infection than for those with a severe infection (median 5 days vs 8 days, P = .021). A nonsignificant trend was observed that indicated higher rates of limb salvage in patients with moderate infections compared with patients with severe infections (94% vs 80%, P = .081).
  
  
  CONCLUSIONS
  Patients with severe DFI had a median hospital stay that was 60% longer than that of patients with moderate DFI. In this sample, 55% of patients with a severe DFI required some type of amputation compared with 42% of patients with a moderate DFI.
  
  
  METHODS
  Level III, retrospective control cohort study.
authors.affiliation: Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. wukichdk@upmc.edu
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.forename: Kimberlee B
authors.initials: KB
authors.lastname: Hobizal
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006801:Humans; D007239:Infections / Q000145:classification / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents