Department of Surgery, Diabetic Foot Unit, 222000La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
Diabetic foot Unit, San Juan de Dios Hospital, San José de Costa Rica, Costa Rica.
Int J Low Extrem Wounds. 2022 Dec;21(4):651-657. doi: 10.1177/15347346221116740. Epub 2022 Aug 4.
We aimed to validate the value of adding osteomyelitis (OM) to moderate and severe categories of diabetic foot infections (DFIs) classification. We conducted a prospective study of a cohort of 200 patients with moderate and severe infections. Variables associated with prognosis were need for any amputation, major amputation, need for hospitalization, length of hospitalization, length of antibiotic therapy, reinfection rate and infection-related mortality. Infections were moderate in 111 cases (55.5%) and severe in 89 (44.5%). OM was diagnosed in 114 cases (57%), 73 presented as moderate (36.5%) and 41 as severe (20.5%). Overall, 129 patients (64.5%) were admitted for a median of 15 days (IQR 13) and 71 (35.5%) were treated as outpatients (day-surgery). Ninety-four patients (47%) were exclusively treated with intravenous antibiotics, 35 (17.5%) with intravenous and then shifting to oral, 16 (8%) exclusively with oral antibiotics, and 55 (27.5%) without antibiotics. Definitive surgery that led to the arrest of the infection was as follows: 117 patients (58.5%) underwent surgical debridement without amputation, and 69 (34.5%) underwent minor and 14 (7%) major amputation. Patients with OM presented as severe had a higher rate of amputations, major amputations, hospitalizations and need for antibiotic therapy when compared with OM presented as moderate. OM is strongly recommended to be added to the moderate and severe categories of the Infectious Diseases Society of America/International Working Group on Diabetic Foot severity system, as recommended by the International Working Group on Diabetic Foot 2019 guidelines.
我们旨在验证将骨髓炎（OM）纳入糖尿病足感染（DFI）中度和重度分类的价值。我们对 200 例中度和重度感染患者进行了前瞻性研究。与预后相关的变量包括任何截肢、大截肢、住院需要、住院时间、抗生素治疗时间、再感染率和感染相关死亡率。111 例（55.5%）感染为中度，89 例（44.5%）为重度。OM 诊断为 114 例（57%），73 例为中度（36.5%），41 例为重度（20.5%）。总体而言，129 例患者（64.5%）住院中位数为 15 天（IQR 13），71 例（35.5%）为门诊（日间手术）治疗。94 例患者（47%）仅接受静脉抗生素治疗，35 例（17.5%）先静脉后转为口服，16 例（8%）仅口服抗生素，55 例（27.5%）未用抗生素。导致感染停止的确定性手术如下：117 例患者（58.5%）行清创术无截肢，69 例（34.5%）行小截肢，14 例（7%）行大截肢。与 OM 中度表现相比，OM 重度表现患者的截肢率、大截肢率、住院率和抗生素治疗需求更高。国际糖尿病足工作组 2019 年指南建议，将骨髓炎强烈推荐纳入美国传染病学会/国际糖尿病足工作组糖尿病足严重程度系统的中度和重度类别。
