Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지

Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot

당뇨발 절단에 있어 원인 감염균과 치료 결과와의 관계

  • Lee, Myoung Jin (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Lee, Kyu Yeol (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Kim, Sung Soo (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Kim, Chul Hong (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Wang, Lih (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Kim, Hyeon Jun (Department of Orthopedic Surgery, College of Medicine, Dong-A University) ;
  • Kim, Ki Woong (Department of Orthopedic Surgery, College of Medicine, Dong-A University)
  • 이명진 (동아대학교 의과대학 정형외과학교실) ;
  • 이규열 (동아대학교 의과대학 정형외과학교실) ;
  • 김성수 (동아대학교 의과대학 정형외과학교실) ;
  • 김철홍 (동아대학교 의과대학 정형외과학교실) ;
  • 왕립 (동아대학교 의과대학 정형외과학교실) ;
  • 김현준 (동아대학교 의과대학 정형외과학교실) ;
  • 김기웅 (동아대학교 의과대학 정형외과학교실)
  • Received : 2013.07.14
  • Accepted : 2013.08.20
  • Published : 2013.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. Materials and Methods: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. Results: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. Conclusion: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

Keywords

References

  1. Reiber GE, Ledoux WR. Epidemiology of foot ulcers and amputations in people with diabetes: Evidence for prevention. In: Herman WH, Kinmonth AL, Wareham NJ, Williams R, ed. Chichester, UK: John Wiley & Sons; 2010. 403-17.
  2. Pecoraro RE, Ahroni JH, Boyko EJ, Stensel VL. Chronology and determinants of tissue repair in diabetic lower-extremity ulcers. Diabetes. 1991;40:1305-13. https://doi.org/10.2337/diab.40.10.1305
  3. Leichter SB, Allweiss P, Harley J, et al. Clinical characteristics of diabetic patients with serious pedal infections. Metabolism. 1988;37:22-4.
  4. Brodsky JW. Evaluation of the diabetic foot. Instr Course Lect. 1999;48:289-303.
  5. Lee JS, Lu M, Lee VS, Russel lD, Bahr C, Lee ET. Lowerextremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study. Diabetes. 1993;42:876-82. https://doi.org/10.2337/diab.42.6.876
  6. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28. https://doi.org/10.1001/jama.293.2.217
  7. American Diabetes Association. Preventive foot care in people with diabetes. Diabetes Care. 1998;2178-79.
  8. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care. 1989;12:24-31. https://doi.org/10.2337/diacare.12.1.24
  9. Ecker ML, Jacobs BS. Lower extremity amputation in diabetic patients. Diabetes. 1970;19:189-95. https://doi.org/10.2337/diab.19.3.189
  10. Boulton AJ, Vi leikyte L, Ragnarson-Tennval lG, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719-24. https://doi.org/10.1016/S0140-6736(05)67698-2
  11. Chow I, Lemos EV, Einarson TR. Management and prevention of diabetic foot ulcers and infections: a health economic review. Pharmacoeconomics. 2008;26:1019-35. https://doi.org/10.2165/0019053-200826120-00005
  12. Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complications. 2005;19:138-41. https://doi.org/10.1016/j.jdiacomp.2004.06.001
  13. Sharma VK, Khadka PB, Joshi A, Sharma R. Common pathogens isolated in foot infection in Bir Hospital. Kathmandu Univ Med J(KUMJ). 2006;4:295-301.
  14. Pinzur MS, Sage R, Stuck R, Osterman H. Amputations in the diabetic foot and ankle. Clin Orthop. 1993;296:64-7.
  15. Burgess EM, Romano RL, Zettl JH, Schrock RD Jr. Amputations of the leg for peripheral vascular insufficiency. J Bone Joint Surg Am. 1971;53-A:874-90.
  16. Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year followup study. Diabetes Care. 2004;27:1598-604. https://doi.org/10.2337/diacare.27.7.1598
  17. Izumi Y, Satterfield K, Lee S, Harkless LB, Lavery LA. Mortality of first-time amputees in diabetics: a 10-year observation. Diabetes Res Clin Pract. 2009;83:126-31. https://doi.org/10.1016/j.diabres.2008.09.005
  18. Papazafiropoulou A, Tentolouris N, Soldatos RP, et al. Mortality in diabetic and nondiabetic patients after amputations performed from 1996 to 2005 in a tertiary hospital population: a 3-year follow-up study. J Diabetes Complications. 2009;23:7-11. https://doi.org/10.1016/j.jdiacomp.2007.11.008
  19. Tseng CH, Chong CK, Tseng CP, Cheng JC, Wong MK, Tai TY. Mortality, causes of death and associated risk factors in a cohort of diabetic patients after lower-extremity amputation: a 6.5-year follow-up study in Taiwan. Atherosclerosis. 2008; 197:111-7. https://doi.org/10.1016/j.atherosclerosis.2007.02.011