Abstract：
BACKGROUND: Diabetes-related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes-related foot infections.
METHODS: A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM) using chi-square tests.
RESULTS: Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST-DFI (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI a greater number of infection failures were observed in the presence of peripheral arterial disease (PAD) compared to the patients without PAD (failure occurred in 30% (31/103) of episodes with PAD and 12% (27/223) of episodes without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78).
CONCLUSIONS: This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It highlights the association of PAD and treatment failure, reinforcing the need for early intervention to improve PAD in patients with DFI. Future randomised trials should assess the benefits of revascularisation and surgery in people with DFI and particularly those with OM where outcomes are worse.
METHODS: A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM) using chi-square tests.
RESULTS: Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST-DFI (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI a greater number of infection failures were observed in the presence of peripheral arterial disease (PAD) compared to the patients without PAD (failure occurred in 30% (31/103) of episodes with PAD and 12% (27/223) of episodes without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78).
CONCLUSIONS: This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It highlights the association of PAD and treatment failure, reinforcing the need for early intervention to improve PAD in patients with DFI. Future randomised trials should assess the benefits of revascularisation and surgery in people with DFI and particularly those with OM where outcomes are worse.
摘要：
背景：糖尿病相关的足部感染很常见，并且是一个重要的临床挑战。关于大型队列结果的数据很少。这项研究的目的是报告大量糖尿病相关足部感染患者的临床结果。
方法：2018年建立了三级转诊医院保肢服务数据库，并使用电子数据库（REDCap）前瞻性捕获了所有新的足部感染发作。2018年1月至2023年5月期间患有足部感染的人，可以获得感染发作的完整数据。包括在内。使用卡方检验比较皮肤和软组织感染（SST-DFI）和骨髓炎（OM）之间的感染结果。
结果：数据提取在397例患者中确定了647例完全DFI发作。将数据集分为两组，将每个感染事件及其严重程度确定为SST-DFI（N=326，50％）或OM（N=321，50％）。大多数感染表现被归类为中度（PEDIS3=327，51%），36％轻度（PEDIS2=239）和13％重度（PEDIS4=81）。感染消退发生在69%(n=449)的发作中，失败发生率为31%(n=198)。OM比SST-DFI更常见感染失败(OM=140，71%vs.SST-DFI=58，29%，p<0.00001)。在SST-DFI患者中，与没有PAD的患者相比，在存在外周动脉疾病（PAD）的情况下观察到更多的感染失败（失败发生在30％（31/103）的PAD发作和12％（27/223）的PAD发作中；p<0.001）。相比之下,在有和无PAD的患者中观察到的OM发作中感染失败的数量相似(失败发生在45%(57/128)的PAD发作和55%(83/193)的无PAD发作中;p=0.78).
结论：本研究提供了澳大利亚DFI不良结局风险和不良结局相关因素的重要流行病学数据。它强调了PAD和治疗失败的关联，加强对早期干预以改善DFI患者PAD的需求。未来的随机试验应评估DFI患者的血运重建和手术的益处，尤其是预后较差的OM患者。
方法：2018年建立了三级转诊医院保肢服务数据库，并使用电子数据库（REDCap）前瞻性捕获了所有新的足部感染发作。2018年1月至2023年5月期间患有足部感染的人，可以获得感染发作的完整数据。包括在内。使用卡方检验比较皮肤和软组织感染（SST-DFI）和骨髓炎（OM）之间的感染结果。
结果：数据提取在397例患者中确定了647例完全DFI发作。将数据集分为两组，将每个感染事件及其严重程度确定为SST-DFI（N=326，50％）或OM（N=321，50％）。大多数感染表现被归类为中度（PEDIS3=327，51%），36％轻度（PEDIS2=239）和13％重度（PEDIS4=81）。感染消退发生在69%(n=449)的发作中，失败发生率为31%(n=198)。OM比SST-DFI更常见感染失败(OM=140，71%vs.SST-DFI=58，29%，p<0.00001)。在SST-DFI患者中，与没有PAD的患者相比，在存在外周动脉疾病（PAD）的情况下观察到更多的感染失败（失败发生在30％（31/103）的PAD发作和12％（27/223）的PAD发作中；p<0.001）。相比之下,在有和无PAD的患者中观察到的OM发作中感染失败的数量相似(失败发生在45%(57/128)的PAD发作和55%(83/193)的无PAD发作中;p=0.78).
结论：本研究提供了澳大利亚DFI不良结局风险和不良结局相关因素的重要流行病学数据。它强调了PAD和治疗失败的关联，加强对早期干预以改善DFI患者PAD的需求。未来的随机试验应评估DFI患者的血运重建和手术的益处，尤其是预后较差的OM患者。
