Invasive Systemic Infection After Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival
Invasive Systemic Infection After Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival
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DOI：
10.1093/cid/ciw736
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发表时间：
2017-02-01
影响因子：
11.8
通讯作者：
Karchmer, Adolf W.
中科院分区：
文献类型：
--
作者：
Chen, Shey-Ying;Giurini, John M.;Karchmer, Adolf W.
背景。糖尿病足溃疡 (DFU) 会威胁四肢并导致住院治疗。住院后，可能会发生与 DFU 相关的远端侵袭性全身感染（DFU-ISI）。 DFU-ISI 的特征及其对死亡风险的影响尚未确定。方法。我们对 9 年期间因 1212 例独特 DFU 住院治疗的 819 名糖尿病患者进行了一项回顾性队列研究。我们将指数溃疡定义为第一次（指数）DFU 入院时出现的溃疡。我们将 DFU-ISI 定义为首次住院后发生的非足部感染，由首次溃疡同时或之前培养的微生物引起。我们确定了与 DFU-ISI 相关的频率、危险因素和死亡风险。结果。 1212 例 DFU 住院治疗后，141 名患者出现 172 例 DFU-ISI。在最初的 141 例 DFU-ISI 中，64% 为菌血症，13% 为深部脓肿，10% 为肺炎，7% 为心内膜炎，6% 为骨骼感染。 57% 的 ISI 是由耐甲氧西林金黄色葡萄球菌 (MRSA) 引起的。初始 DFU 培养结果产生 MRSA 且存在迁延性开放性溃疡的患者，24 个月累积 DFU-ISI 概率较高（31%），全因死亡率较高（13%）。 Cox 回归模型分析显示，复杂性溃疡愈合（风险比，3.812；95% 置信区间，2.434-5.971）和初始 DFU 培养产生 MRSA（2.030；1.452-2.838）可预测 DFU-ISI，并且 DFU-ISI 与死亡风险增加相关（1.987；1.106-3.568）。结论。 DFU-ISI 是 DFU 的重要晚期并发症。应前瞻性研究 DFU-ISIs 的预防。与此同时，临床医生应积极将加速溃疡愈合的治疗方法和针对 MRSA 的治疗纳入糖尿病足溃疡患者的护理中。
Background. Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined.Methods. We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs.Results. After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicillin-resistant Staphylococcus aureus (MRSA) caused 57% of the ISIs. Patients with initial DFU cultures yielding MRSA and protracted open ulcers had a high 24-month cumulative probability of DFU-ISI (31%) and all-cause mortality rate (13%). Analysis with Cox regression modeling showed that complicated ulcer healing (hazard ratio, 3.812; 95% confidence interval, 2.434-5.971) and initial DFU culture yielding MRSA (2.030; 1.452-2.838) predicted DFU-ISIs and that DFU-ISIs were associated with increased mortality risk (1.987; 1.106-3.568).Conclusions. DFU-ISIs are important late complications of DFUs. Prevention of DFU-ISIs should be studied prospectively. Meanwhile, clinicians should aggressively incorporate treatment to accelerate ulcer healing and address MRSA into the care of diabetic patients with foot ulcers.