title: Diabetic foot infection in hospitalized adults.
abstract: BACKGROUND
  Acute infections of the diabetic foot (DFI) are a common and complex condition. Patients are generally managed in the ambulatory setting and epidemiological data pertaining to hospitalized patients is lacking. The aim of this study was to analyze the epidemiology, microbiology and outcomes of hospitalized patients with DFI, who are managed at a referral center equipped with hyperbaric oxygen (HBO) therapy.
  
  
  METHODS
  A retrospective cohort study of adult patients admitted to a tertiary referral center with DFI over a six-month period in 2013 was undertaken. Predictors of clinical outcomes and efficacy of treatment modalities were analyzed by Cox regression.
  
  
  RESULTS
  Sixty-one patients with DFI were identified. Most patients were elderly (67 ± 13 years), with long-standing (17 ± 9 years), poorly controlled (HbA1c 9 ± 3%) diabetes. Most patients had polymicrobial infection (80%); specifically, anaerobic (39%) and multi or extensively-drug resistant organisms (61%). Administration of appropriate antimicrobials was delayed for >48 h in 83%. Advanced age was associated with worse outcomes. Sicker patients with severe peripheral vascular disease were managed with HBO. The use of HBO was associated with higher costs and increased functional deterioration, and did not prevent future limb amputation.
  
  
  CONCLUSIONS
  Our study illustrates the descriptive epidemiology of hospitalized adults with DFI predominantly of polymicrobial etiology. MDROs and anaerobic organisms are common causative pathogens, and appropriate antibiotics were frequently delayed. HBO treatment may delay the need for limb amputation, but not obviate this eventual outcome.
authors.affiliation: Department of Internal Medicine D, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: David E
authors.initials: DE
authors.lastname: Katz
authors.affiliation: Department of Infectious Diseases, Barwon Health, Victoria, Australia.
authors.forename: N Deborah
authors.initials: ND
authors.lastname: Friedman
authors.affiliation: Department of Internal Medicine D, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Evgenia
authors.initials: E
authors.lastname: Ostrovski
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Dor
authors.initials: D
authors.lastname: Ravid
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Nadav
authors.initials: N
authors.lastname: Amrami
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Dori
authors.initials: D
authors.lastname: Avivi
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Bethlehem
authors.initials: B
authors.lastname: Mengesha
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Zaidenstein
authors.affiliation: Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Tsilia
authors.initials: T
authors.lastname: Lazarovitch
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Mor
authors.initials: M
authors.lastname: Dadon
authors.affiliation: Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: drormarchaim@gmail.com.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017719:Diabetic Foot / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; DFI; Diabetes; Hyperbaric oxygen; SSTI; Skin and soft tissue infections