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

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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
Early online date30 Oct 2017
DOIs
Publication statusPublished - Jan 2018

Fingerprint

Diabetic Foot
Ulcer
Observational Studies
Prospective Studies
Lower Extremity
Amputation
Incidence
Perfusion
Wound Healing
Foot
Ischemia
Extremities
Anti-Bacterial Agents
Recurrence

Keywords

  • diabetic foot ulcer
  • antibiotic
  • amputation
  • risk analysis

Cite this

Ndosi, M. ; Wright-Hughes, A. ; Brown, S. ; Backhouse, M. ; Lipsky, B. A. ; Bhogal, M. ; Reynolds, C. ; Vowden, P. ; Jude, E. B. ; Nixon, J. ; Nelson, E. A. / Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. In: Diabetic Medicine. 2018 ; Vol. 35. pp. 78-88.
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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.",
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Ndosi, M, Wright-Hughes, A, Brown, S, Backhouse, M, Lipsky, BA, Bhogal, M, Reynolds, C, Vowden, P, Jude, EB, Nixon, J & Nelson, EA 2018, 'Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study', Diabetic Medicine, vol. 35, pp. 78-88. https://doi.org/10.1111/dme.13537

Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. / Ndosi, M.; Wright-Hughes, A.; Brown, S.; Backhouse, M.; Lipsky, B. A.; Bhogal, M.; Reynolds, C.; Vowden, P.; Jude, E. B.; Nixon, J.; Nelson, E. A.

In: Diabetic Medicine, Vol. 35, 01.2018, p. 78-88.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study

AU - Ndosi, M.

AU - Wright-Hughes, A.

AU - Brown, S.

AU - Backhouse, M.

AU - Lipsky, B. A.

AU - Bhogal, M.

AU - Reynolds, C.

AU - Vowden, P.

AU - Jude, E. B.

AU - Nixon, J.

AU - Nelson, E. A.

N1 - Acceptance from webpage

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - diabetic foot ulcer

KW - antibiotic

KW - amputation

KW - risk analysis

U2 - 10.1111/dme.13537

DO - 10.1111/dme.13537

M3 - Article

VL - 35

SP - 78

EP - 88

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

ER -

Ndosi M, Wright-Hughes A, Brown S, Backhouse M, Lipsky BA, Bhogal M et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabetic Medicine. 2018 Jan;35:78-88. https://doi.org/10.1111/dme.13537