Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study

M. Ndosi*, A. Wright-Hughes, S. Brown, M. Backhouse, B. A. Lipsky, M. Bhogal, C. Reynolds, P. Vowden, E. B. Jude, J. Nixon, E. A. Nelson

*Corresponding author for this work

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Abstract

Aims
To determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer.

Methods
This multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence.

Results
In the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).

Conclusions
Clinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.
Original languageEnglish
Pages (from-to)78-88
Number of pages11
JournalDiabetic Medicine
Volume35
Issue number1
Early online date30 Oct 2017
DOIs
Publication statusPublished - Jan 2018

Keywords

  • diabetic foot ulcer
  • antibiotic
  • amputation
  • risk analysis

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