%0 Journal Article
%T Predictive factors for lower extremity amputations in diabetic foot infections
%A Zameer Aziz
%A Wong Keng Lin
%A Aziz Nather
%A Chan Yiong Huak
%J Diabetic Foot & Ankle
%D 2011
%I Co-Action Publishing
%R 10.3402/dfa.v2i0.7463
%X The objective of this study was to evaluate the epidemiology of diabetic foot infections (DFIs) and its predictive factors for lower extremity amputations. A prospective study of 100 patients with DFIs treated at the National University Hospital of Singapore were recruited in the study during the period of January 2005¨CJune 2005. A protocol was designed to document patient's demographics, type of DFI, presence of neuropathy and/or vasculopathy and its final outcome. Predictive factors for limb loss were determined using univariate and stepwise logistic regression analysis. The mean age of the study population was 59.8 years with a male to female ratio of about 1:1 and with a mean follow-up duration of about 24 months. All patients had type 2 diabetes mellitus. Common DFIs included abscess (32%), wet gangrene (29%), infected ulcers (19%), osteomyelitis (13%), necrotizing fasciitis (4%) and cellulitis (3%). Thirteen patients were treated conservatively, while surgical debridement or distal amputation was performed in 59 patients. Twenty-eight patients had major amputations (below or above knee) performed. Forty-eight percent had monomicrobial infections compared with 52% with polymicrobial infections. The most common pathogens found in all infections (both monomicrobial and polymicrobial) were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeruginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictive factors for limb loss included age above 60 years, gangrene, ankle-brachial index (ABI) <0.8, monomicrobial infections, white blood cell (WBC) count ¡Ý 15.0¡Á109/L, erythrocyte sedimentation rate ¡Ý100 mm/hr, C-reactive protein ¡Ý15.0 mg/dL, hemoglobin (Hb) ¡Ü10.0g/dL and creatinine ¡Ý150 ¦Ìmol/L. Upon stepwise logistic regression, only gangrene, ABI <0.8, WBC ¡Ý 15.0¡Á109/L and Hb ¡Ü10.0g/dL were significant.
%K gangrene
%K diabetes mellitus
%K amputation
%K ulceration
%U http://diabeticfootandankle.net/index.php/dfa/article/view/7463/pdf