Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia.
School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
J Foot Ankle Res. 2020 Nov 4;13(1):65. doi: 10.1186/s13047-020-00433-9.
Diabetes foot ulcer is a devastating and much-feared complication of diabetes. Diabetes foot ulcerations which developed gangrene can take weeks or months to heal and can sometimes not heal at all so that amputation for non-traumatic causes is a frequent outcome in the diabetic foot. Despite this, there is no finding on predictors of the amputation rate of diabetes foot ulcers in Ethiopia. Hence this study was aimed to identify factors associated with the amputation rate of diabetes foot ulcer patients in Nekemte referral hospital.
A prospective observational study was conducted among adult diabetes foot ulcer patients admitted to Nekemte referral hospital from March 15 to June 15, 2018. A pus swab was obtained from the ulcers before any ulcer cleaning to conduct gram staining. The primary outcome was the amputation rate. Cox regression analysis was used to estimate the hazard ratios and time from study entry to healing was evaluated as censored event times by Kaplan-Meier curves.
Over the study period, 115 diabetes foot ulcer patients were admitted to the NRH; of these patients, 64(55.65%) were males while the mean age of participants was 44.4 ± 14.7. A total of 34(29.57%) of the diabetes foot ulcer were overweight and 16(13.91%) were obese while the mean ± standard deviation of body mass index (BMI) was 24.94 ± 3.69 kg/m2 and a total of 56(48.69%) diabetic foot ulcer had a diabetic complication. Of patients with diabetic foot ulcer, 35(30.43%) were undergone lower extremity amputations (LEA). Patients who were prescribed with inappropriate antibiotics were unlikely to heal. A total of 18(46.15%) of the patients who were taken inappropriate antibiotics were healed whereas 21(53.85%) were not healed (P = 0.017). Besides, the higher the Wagner grade, the worse the outcome of healing. A total of 19(21.84%) and 16(57.14%) of patients with grade < 4 and grade ≥ 4, respectively, did not heal (P = 0.005).
The amputation rate of diabetes foot ulcers was rapid for patients prescribed inappropriate antibiotics and higher grades of the foot ulcer. Therefore, the presence of clinical pharmacists plays a pivotal role to promote the appropriate use of antibiotics and besides the daily care, special attention should be given for patients having an advanced grade of diabetes foot ulcer.
糖尿病足溃疡是糖尿病的一种破坏性且令人恐惧的并发症。发生坏疽的糖尿病足溃疡可能需要数周或数月才能愈合，有时甚至根本无法愈合，因此非创伤性原因导致截肢是糖尿病足的常见后果。尽管如此，在埃塞俄比亚，并没有关于糖尿病足溃疡截肢率预测因素的发现。因此，本研究旨在确定与内克姆特转诊医院糖尿病足溃疡截肢率相关的因素。
这是一项前瞻性观察性研究，于 2018 年 3 月 15 日至 6 月 15 日在内克姆特转诊医院收治的成年糖尿病足溃疡患者中进行。在进行任何溃疡清洁之前，从溃疡处获得脓液拭子进行革兰氏染色。主要结局是截肢率。使用 Cox 回归分析估计风险比，通过 Kaplan-Meier 曲线评估从研究入组到愈合的时间为删失事件时间。
在研究期间，共有 115 例糖尿病足溃疡患者入住 NRH；其中 64 例（55.65%）为男性，参与者的平均年龄为 44.4±14.7 岁。共有 34 例（29.57%）糖尿病足溃疡患者超重，16 例（13.91%）肥胖，体重指数（BMI）的平均值±标准差为 24.94±3.69kg/m2，共有 56 例（48.69%）糖尿病足溃疡患者存在糖尿病并发症。在糖尿病足溃疡患者中，有 35 例（30.43%）接受了下肢截肢（LEA）。接受不适当抗生素治疗的患者不太可能愈合。接受不适当抗生素治疗的 18 例（46.15%）患者中，有 18 例（46.15%）愈合，21 例（53.85%）未愈合（P=0.017）。此外，Wagner 分级越高，愈合效果越差。分别有 19 例（21.84%）和 16 例（57.14%）分级<4 级和分级≥4 级的患者未愈合（P=0.005）。
接受不适当抗生素治疗和足部溃疡分级较高的糖尿病足溃疡患者的截肢率较快。因此，临床药师的存在对于促进抗生素的合理使用起着关键作用。此外，除了日常护理外，还应特别注意患有高级别糖尿病足溃疡的患者。
