Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study

Ndosi, M.; Wright-Hughes, Alexandra; Brown, Sarah; Backhouse, Michael; Lipsky, Benjamin A; Bhogal, Moninder; Reynolds, Catherine; Vowden, Peter; Jude, Edward; Nixon, Jane; Nelson, E. Andrea

Abstract

© 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK Aims: To determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer. Methods: This multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence. Results: In the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06). Conclusions: Clinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.

• Journal Article Type: Article
• Acceptance Date: Oct 25, 2017
• Online Publication Date: Oct 30, 2017
• Publication Date: Jan 1, 2018
• Deposit Date: Oct 23, 2017
• Publicly Available Date: Dec 12, 2017
• Journal: Diabetic Medicine
• Print ISSN: 0742-3071
• Electronic ISSN: 1464-5491
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 1
• Pages: 78-88
• DOI: https://doi.org/10.1111/dme.13537
• Keywords: diabetic foot ulcer, infection, long-term outcomes, prognosis, observational study
• Public URL: https://uwe-repository.worktribe.com/output/871911
• Publisher URL: http://dx.doi.org/10.1111/dme.13537
• Contract Date: Oct 23, 2017