title: Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey.
abstract: We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.
authors: Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: saltoglu.nese@gmail.com.
authors: N
authors: N
authors: Saltoglu
authors: Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: M
authors: M
authors: Yemisen
authors: Koc University, School of Medicine, Infectious Diseases, Istanbul, Turkey.
authors: O
authors: O
authors: Ergonul
authors: Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: A
authors: A
authors: Kadanali
authors: Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: G
authors: G
authors: Karagoz
authors: Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: A
authors: A
authors: Batirel
authors: Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: O
authors: O
authors: Ak
authors: Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: H
authors: H
authors: Eraksoy
authors: Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: A
authors: A
authors: Cagatay
authors: Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: A
authors: A
authors: Vatan
authors: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: G
authors: G
authors: Sengoz
authors: Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: F
authors: F
authors: Pehlivanoglu
authors: Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: T
authors: T
authors: Aslan
authors: Bezmialem University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Y
authors: Y
authors: Akkoyunlu
authors: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: D
authors: D
authors: Engin
authors: Haydarpasa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: N
authors: N
authors: Ceran
authors: Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: B
authors: B
authors: Erturk
authors: Marmara University, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: L
authors: L
authors: Mulazimoglu
authors: Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: O
authors: O
authors: Oncul
authors: Gulhane Military Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: H
authors: H
authors: Ay
authors: Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: F
authors: F
authors: Sargin
authors: Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: N
authors: N
authors: Ozgunes
authors: Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: F
authors: F
authors: Simsek
authors: Okmeydani Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: T
authors: T
authors: Yildirmak
authors: Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors: N
authors: N
authors: Tuna
authors: Sakarya University Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors: O
authors: O
authors: Karabay
authors: Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: K
authors: K
authors: Yasar
authors: Sisli Etfal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: N
authors: N
authors: Uzun
authors: Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: Y
authors: Y
authors: Kucukardali
authors: Yeditepe University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: M
authors: M
authors: Sonmezoglu
authors: Goztepe Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: F
authors: F
authors: Yilmaz
authors: Samatya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: U
authors: U
authors: Tozalgan
authors: Dr Lutfi Kirdar Kartal Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: S
authors: S
authors: Ozer
authors: Istanbul University, Cerrahpasa Medical School, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors: M
authors: M
authors: Ozyazar
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
keywords: Antimicrobial resistance; Gram-negative; diabetic foot; infections; limb loss