Lavery Lawrence A, Armstrong David G, Wunderlich Robert P, Mohler M Jane, Wendel Christopher S, Lipsky Benjamin A
Department of Surgery, Scott and White Hospital, Texas A&M University Health Science Center College of Medicine, Temple, TX, USA.
Diabetes Care. 2006 Jun;29(6):1288-93. doi: 10.2337/dc05-2425.
To prospectively determine risk factors for foot infection in a cohort of people with diabetes.
We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.
During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture-proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3-102.2; P < 0.001) and the risk of amputation was 154.5 times greater (58.5-468.5; P < 0.001). Foot wounds preceded all but one infection. Significant (P < 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration >30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).
Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.
前瞻性确定糖尿病患者队列中足部感染的危险因素。
在一项为期2年的纵向结局研究中，我们评估并随访了1666例连续纳入基于管理式医疗的门诊诊所的糖尿病患者。入组时，患者接受了标准化的全身医学检查和详细的足部评估，并接受了足部护理的教育。然后定期对他们进行重新筛查，如果他们出现任何足部问题也会及时就诊。
在评估期间，151例（9.1%）患者发生了199次足部感染，除1例以外均涉及伤口或穿透伤。大多数患者的感染仅累及软组织，但19.9%有经骨培养证实的骨髓炎。与未发生足部感染的患者相比，发生足部感染的患者住院风险高55.7倍（95%可信区间30.3 - 102.2；P < 0.001），截肢风险高154.5倍（58.5 - 468.5；P < 0.001）。除1例感染外，所有感染之前均有足部伤口。多因素分析中足部感染的显著（P < 0.05）独立危险因素包括穿透至骨的伤口（比值比6.7）、持续时间>30天的伤口（4.7）、复发性伤口（2.4）、有创伤病因的伤口（2.4）以及存在外周血管疾病（1.9）。
足部感染在糖尿病患者中相对频繁发生，几乎总是继发于创伤，并显著增加住院和截肢风险。预防感染的努力应针对有创伤性足部伤口的患者，尤其是那些慢性、深部、复发性或与外周血管疾病相关的伤口。
