Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Department of Plastic and Reconstructive Surgery, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Surg Infect (Larchmt). 2022 Sep;23(7):667-674. doi: 10.1089/sur.2022.150.
In this single-center study, we analyzed a retrospective cohort of patients with diabetic foot infections (DFIs) between 2011 and 2020. The first and second five-year periods were compared. A poor prognosis was defined as a primary composite end point including re-infection, major amputation, or mortality at six months. A total of 484 patients were enrolled. Overall, 269 patients had the primary composite end point. A substantial decrease was detected in the second five-year period in terms of re-infection (n = 132, 66.0% vs. n = 68, 23.9%; p < 0.001) and mortality (n = 22, 11.0% vs. n = 7, 2.5%; p < 0.001). A total of 798 micro-organisms were isolated from 484 patients. A substantial increase was detected in polymicrobial infections (48.5% vs. 65.1%; p = 0.001) as well as spp. (2.5% vs. 9.2%; p = 0.003), spp. (9.5% vs. 22.9%; p < 0.001), and extended-spectrum β-lactamase (ESBL) producing (3.0% vs. 12.7%; p < 0.001) in the second five-year period, whereas the prevalence of multi-drug-resistanct (MDR) (17.0% vs. 10.2%; p = 0.029) and carbapenem-resistant (7.5% vs. 2.8%; p = 0.017) decreased. Multivariable regression analysis revealed that MDR (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.074-3.420; p = 0.028) and carbapenem-resistant (OR, 3.069; 95% CI, 1.114-8.453; p = 0.030) were independent predictors for poor prognosis. This 10-year cohort study provides reassuring information about the changing epidemiology of DFIs and the prognostic determinants in patients with DFIs.
在这项单中心研究中，我们分析了 2011 年至 2020 年间患有糖尿病足感染 (DFI) 的患者的回顾性队列。比较了前 5 年和后 5 年两个时期。预后不良定义为主要复合终点，包括 6 个月时再次感染、大截肢或死亡。共纳入 484 例患者。总体而言，269 例患者出现主要复合终点。第二个 5 年期间，再次感染 (n=132，66.0% vs. n=68，23.9%；p<0.001) 和死亡率 (n=22，11.0% vs. n=7，2.5%；p<0.001) 显著降低。从 484 例患者中分离出 798 株微生物。发现混合感染 (48.5% vs. 65.1%；p=0.001)、 spp. (2.5% vs. 9.2%；p=0.003)、 spp. (9.5% vs. 22.9%；p<0.001) 和产超广谱β-内酰胺酶 (ESBL) 的 (3.0% vs. 12.7%；p<0.001) 显著增加，而多药耐药 (MDR) (17.0% vs. 10.2%；p=0.029) 和碳青霉烯耐药 (7.5% vs. 2.8%；p=0.017) 的发生率降低。多变量回归分析显示，MDR (比值比 [OR]，1.917；95%置信区间 [CI]，1.074-3.420；p=0.028) 和碳青霉烯耐药 (OR，3.069；95%CI，1.114-8.453；p=0.030) 是预后不良的独立预测因素。这项为期 10 年的队列研究提供了有关 DFI 流行病学变化和 DFI 患者预后决定因素的可靠信息。
