1Department of Medical Microbiology, Atılım University School of Medicine, Ankara, Turkey.
2Bayındır Healthcare Group, Infectious Diseases Clinic, Sogutozu Hospital, Ankara, Turkey.
J Am Podiatr Med Assoc. 2024 May-Jun;114(3). doi: 10.7547/22-073.
Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality.
This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]).
During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP.
The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.
糖尿病足感染是一个非常重要的公共卫生问题，它会导致严重的健康问题、死亡率和高额的医疗支出，是糖尿病最重要的并发症之一。人们担心，在 2019 年冠状病毒病大流行期间，医生的门诊次数受限、避免去医院以及限制非紧急手术等措施会对糖尿病足患者（包括糖尿病足溃疡[DFU]、缺血和感染）造成威胁，导致更多的肢体丧失和死亡。
本多中心、回顾性、横断面研究在土耳其不同地区的 14 家三级保健医院进行。共评估了 1394 例患者病历，其中 794 例为 2019 年 1 月 1 日至 1 月 30 日（大流行前[Pre-P]），605 例为 2020 年 2 月 1 日至 2021 年 2 月 28 日（大流行期间[PP]）。
在 PP 期间，糖尿病足患者的随访减少了 23.8%。此外，PP 期间因 DFU 住院的人数明显减少（P=.035）。两组患者的人口统计学特征、病史、DFU 严重程度、生化和影像学发现或合并症无差异，但 Pre-P 组患者的糖尿病年数较长（15.1 年 vs. 13.7 年）。两组在主要并发症（如肢体丧失和死亡率）方面无差异，但 PP 组感染复发率高于 Pre-P 组（12.9% vs. 11.4%；P<.05）。PP 期间，DFU 感染的非发酵革兰氏阴性菌作为病原体的患病率增加。特别是，PP 期间耐碳青霉烯假单胞菌的患病率有统计学上的增加。
土耳其多学科糖尿病足护理委员会通过制定和实施各项措施和变革来迅速适应大流行，这可能是大流行期间土耳其 DFU 并发症没有增加的原因。
