Outcomes of Foot Infections Secondary to Puncture Injuries in Patients With and Without Diabetes

David H. Truong, Matthew J. Johnson, Peter A. Crisologo, Dane K. Wukich, Kavitha Bhavan, Javier La Fontaine, Lawrence A. Lavery

Research output: Contribution to journalArticle

Abstract

It is difficult to compare foot infections in patients with diabetes to those without diabetes because foot infections are uncommon in people without diabetes. The aim of this study is to compare clinical outcomes in people with and without diabetes admitted to the hospital for an infected puncture wound. We evaluated 114 consecutive patients from June 2011 to March 2019 with foot infection resulting from a puncture injury; 83 had diabetes and 31 did not have diabetes. We evaluated peripheral arterial disease (PAD), sensory neuropathy, the need for surgery and amputation, length of hospitalization, and presence of osteomyelitis. Patients with diabetes were 31 times more likely to have neuropathy (91.6% versus 25.8%, p < .001, confidence interval [CI] 10.2 to 95.3), 8 times more likely to have PAD (34.9% versus 6.5%, p = .002, CI 1.7 to 35), and 7 times more likely to have kidney disease (19.3% versus 3.2%, p < .05, CI 0.9 to 56.5). They also took longer before presenting to the hospital (mean 20.1 ± 36.3 versus 18.8 ± 34.8 days, p = .09, CI 13 to 26.5); however, this result was not statistically significant. Patients with diabetes were 9 times more likely to have osteomyelitis (37.3% versus 6.5%, p = .001, CI 1.9 to 38.8). In addition, they were more likely to require surgery (95% versus 77%, p < .001, CI 1.6 to 21.4), required more surgeries (2.7 ± 1.3 versus 1.3 ± 0.8, p < .00001, CI 2.1 to 2.5), were 14 times more likely to have amputations (48.2% versus 6.5%, p < .0001, CI 3.0 to 60.2), and had 2 times longer hospital stays (16.2 ± 10.6 versus 7.5 ± 9 days, p = .0001, CI 11.9 to 15.9. Infected puncture wounds in patients with diabetes often fair much worse with more detrimental outcomes than those in patients without diabetes.

Original languageEnglish (US)
Pages (from-to)1064-1066
Number of pages3
JournalJournal of Foot and Ankle Surgery
Volume58
Issue number6
DOIs
StatePublished - Nov 2019

Fingerprint

Coinfection
Punctures
Foot
Confidence Intervals
Wounds and Injuries
Peripheral Arterial Disease
Osteomyelitis
Amputation
Infection
Kidney Diseases
Length of Stay
Hospitalization

Keywords

  • 3
  • diabetic foot infection
  • nondiabetic
  • osteomyelitis
  • outcomes
  • puncture wound

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Outcomes of Foot Infections Secondary to Puncture Injuries in Patients With and Without Diabetes. / Truong, David H.; Johnson, Matthew J.; Crisologo, Peter A.; Wukich, Dane K.; Bhavan, Kavitha; La Fontaine, Javier; Lavery, Lawrence A.

In: Journal of Foot and Ankle Surgery, Vol. 58, No. 6, 11.2019, p. 1064-1066.

Research output: Contribution to journalArticle

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abstract = "It is difficult to compare foot infections in patients with diabetes to those without diabetes because foot infections are uncommon in people without diabetes. The aim of this study is to compare clinical outcomes in people with and without diabetes admitted to the hospital for an infected puncture wound. We evaluated 114 consecutive patients from June 2011 to March 2019 with foot infection resulting from a puncture injury; 83 had diabetes and 31 did not have diabetes. We evaluated peripheral arterial disease (PAD), sensory neuropathy, the need for surgery and amputation, length of hospitalization, and presence of osteomyelitis. Patients with diabetes were 31 times more likely to have neuropathy (91.6{\%} versus 25.8{\%}, p < .001, confidence interval [CI] 10.2 to 95.3), 8 times more likely to have PAD (34.9{\%} versus 6.5{\%}, p = .002, CI 1.7 to 35), and 7 times more likely to have kidney disease (19.3{\%} versus 3.2{\%}, p < .05, CI 0.9 to 56.5). They also took longer before presenting to the hospital (mean 20.1 ± 36.3 versus 18.8 ± 34.8 days, p = .09, CI 13 to 26.5); however, this result was not statistically significant. Patients with diabetes were 9 times more likely to have osteomyelitis (37.3{\%} versus 6.5{\%}, p = .001, CI 1.9 to 38.8). In addition, they were more likely to require surgery (95{\%} versus 77{\%}, p < .001, CI 1.6 to 21.4), required more surgeries (2.7 ± 1.3 versus 1.3 ± 0.8, p < .00001, CI 2.1 to 2.5), were 14 times more likely to have amputations (48.2{\%} versus 6.5{\%}, p < .0001, CI 3.0 to 60.2), and had 2 times longer hospital stays (16.2 ± 10.6 versus 7.5 ± 9 days, p = .0001, CI 11.9 to 15.9. Infected puncture wounds in patients with diabetes often fair much worse with more detrimental outcomes than those in patients without diabetes.",
keywords = "3, diabetic foot infection, nondiabetic, osteomyelitis, outcomes, puncture wound",
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KW - nondiabetic

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