Department of Cardiology, Rakuwakai Otowa Hospital, Kyoto, Japan.
Department of Nephrology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Endovasc Ther. 2024 Jun;31(3):450-456. doi: 10.1177/15266028221134890. Epub 2022 Nov 16.
This study aimed to evaluate the relationship between bacteriological findings and wound healing after minor amputation in the treatment of chronic limb-threatening ischemia (CLTI) with infection.
This single-center retrospective study analyzed 135 consecutive limbs with tissue loss and infection from 120 patients who underwent endovascular therapy (EVT) and minor forefoot amputation for CLTI with wound infection between November 2017 and August 2021. The Kaplan-Meier method was used to assess the rate of wound healing after the procedure. The Cox proportional-hazards model was used to examine the impact of bacteriological findings and baseline characteristics on wound healing.
The wound healing rate at 6 months was 72.6%. In a multivariate analysis, in addition to hemodialysis (hazard ratio [HR]=1.73; p=0.009) and amputation above the metatarsophalangeal (MP) joint (HR=1.81; p=0.006), antimicrobial-resistant bacterial infection (HR=1.80, p=0.004) and polymicrobial infection (H=1.51; p=0.049) were predictors of delayed wound healing.
Antimicrobial-resistant bacterial infection, polymicrobial infection, hemodialysis, and amputation above the MP joint were independent predictors of delayed wound healing after EVT and minor forefoot amputation in patients with CLTI and bacterial wound infection.
In this single-center retrospective study, we analyzed 136 consecutive limbs with tissue loss and infection from 120 patients who underwent endovascular therapy and minor forefoot amputation for chronic limb-threatening ischemia (CLTI) with wound infection between November 2017 and August 2021. Our main findings were that antimicrobial-resistant bacterial infection, polymicrobial infection, hemodialysis, and amputation above the metatarsophalangeal joint were independent predictors of delayed wound healing after minor amputation. This is the first report of the association between bacteriological studies and wound healing in CLTI with infection, and will be of great help in the future clinical practice.
本研究旨在评估慢性肢体威胁性缺血（CLTI）伴感染患者行血管腔内治疗（EVT）联合小足趾截肢术后，细菌学检查结果与小截肢术后伤口愈合的关系。
本单中心回顾性研究分析了 2017 年 11 月至 2021 年 8 月期间 120 例因 CLTI 合并感染性伤口而行 EVT 联合小足趾截肢术的患者中，135 例存在组织缺失和感染的连续肢体。采用 Kaplan-Meier 法评估术后伤口愈合率。采用 Cox 比例风险模型分析细菌学检查结果和基线特征对伤口愈合的影响。
6 个月时的伤口愈合率为 72.6%。多变量分析显示，除了血液透析（HR=1.73；p=0.009）和截趾平面高于跖趾关节（HR=1.81；p=0.006）外，抗菌药物耐药菌感染（HR=1.80，p=0.004）和混合细菌感染（HR=1.51；p=0.049）也是延迟伤口愈合的预测因素。
抗菌药物耐药菌感染、混合细菌感染、血液透析和跖趾关节以上截肢是 CLTI 合并细菌感染性伤口患者 EVT 联合小足趾截肢术后伤口愈合延迟的独立预测因素。
在这项单中心回顾性研究中，我们分析了 2017 年 11 月至 2021 年 8 月期间 120 例因慢性肢体威胁性缺血（CLTI）合并感染性伤口而行 EVT 联合小足趾截肢术的患者中 136 例连续肢体的组织缺失和感染情况。我们的主要发现是，抗菌药物耐药菌感染、混合细菌感染、血液透析和跖趾关节以上截肢是小截肢术后伤口愈合延迟的独立预测因素。这是首次报道 CLTI 合并感染患者的细菌学研究与伤口愈合之间的关系，这将对未来的临床实践有很大帮助。
