Division of Infectious Diseases, Department of Medicine, and.
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, Taipei.
Clin Infect Dis. 2017 Feb 1;64(3):326-334. doi: 10.1093/cid/ciw736. Epub 2016 Nov 10.
Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined.
We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs.
After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicillin-resistant Staphylococcus aureus (MRSA) caused 57% of the ISIs. Patients with initial DFU cultures yielding MRSA and protracted open ulcers had a high 24-month cumulative probability of DFU-ISI (31%) and all-cause mortality rate (13%). Analysis with Cox regression modeling showed that complicated ulcer healing (hazard ratio, 3.812; 95% confidence interval, 2.434-5.971) and initial DFU culture yielding MRSA (2.030; 1.452-2.838) predicted DFU-ISIs and that DFU-ISIs were associated with increased mortality risk (1.987; 1.106-3.568).
DFU-ISIs are important late complications of DFUs. Prevention of DFU-ISIs should be studied prospectively. Meanwhile, clinicians should aggressively incorporate treatment to accelerate ulcer healing and address MRSA into the care of diabetic patients with foot ulcers.
糖尿病足溃疡（DFU）威胁四肢并促使住院治疗。住院后，DFU 相关的远程部位侵袭性全身感染（DFU-ISI）可能发生。DFU-ISIs 的特征及其对死亡风险的影响尚未明确。
我们对 819 名糖尿病患者进行了回顾性队列研究，这些患者在 9 年期间因 1212 例独特的 DFU 住院治疗。我们将索引溃疡定义为首次（索引）DFU 入院时存在的溃疡。我们将 DFU-ISI 定义为索引住院后发生的非足部感染，由同时或先前从索引溃疡培养的微生物引起。我们确定了 DFU-ISIs 的频率、危险因素和死亡风险。
在 1212 次索引 DFU 住院治疗后，141 名患者发生了 172 次 DFU-ISI。最初的 141 次 DFU-ISI 中，64%为菌血症，13%为深部脓肿，10%为肺炎，7%为心内膜炎，6%为骨骼感染。耐甲氧西林金黄色葡萄球菌（MRSA）引起了 57%的感染。初始 DFU 培养物产生 MRSA 和溃疡长期开放的患者，DFU-ISI（31%）和全因死亡率（13%）的 24 个月累积概率均较高。使用 Cox 回归模型进行分析表明，复杂的溃疡愈合（危险比，3.812；95%置信区间，2.434-5.971）和初始 DFU 培养物产生 MRSA（2.030；1.452-2.838）预测 DFU-ISIs，而 DFU-ISIs 与死亡风险增加相关（1.987；1.106-3.568）。
DFU-ISIs 是 DFU 的重要晚期并发症。应前瞻性研究 DFU-ISIs 的预防。同时，临床医生应积极采用治疗方法加速溃疡愈合，并将治疗 MRSA 纳入足部溃疡糖尿病患者的护理中。
