Study On Risk Factors For Developing Osteomyelitis And Amputation In Diabetic Foot Patients

Objective:To investigate the clinical characteristics, therapeutic process and clinical outcomes of the diabetic foot osteomyelitis (DFO) patients, to explore the risk factors for developing osteomyelitis and amputation.Methods:1. According to the inclusion criteria and exclusion criteria,575DF patients hospitalized in DF unit between Jul2008and Jul2012were included in this study, they were all diagnosed with diabetes mellitus.2. According to patient with or without DFO, patients were divided into DFO group and non-DFO group. According to patient with or without amputation, patients were divided into amputation group and non-amputation group.3. The medical history,clinical manifestations, laboratory and physical examination results, treatments and prognosis of groups were compared.4.Risk factors were analyzed with Multivariate nonconditional logistic regression.Results:1. Description of the characteristics of patients with DFO:The proportion of male and female patients were64.0%and36.0%.The mean age,diabetes duration, duration of DF was65.16±10.79and13.58±8.12years,7(12)weeks respectively. The mean estimated S(AD)SAD score was13(2).20%-40%patients had fever, foot ulcer history, multiple foot ulcers,cerebral vascular disease, leukocytosis.40%-60%patients had smoking history, high blood pressure, diabetic retinopathy, hyperlipidemia, malodor, critical limb ischemia(CLI), edema, loss of protection sensation, albumin(ALB)<35g/L, glycosylated hemoglobin(GHbAlc)>9.0%, erythrocyte sedimentation rete(ESR)>40mm/h, granulocyte increased,anemia. More than60%patients had foot ulcer area>4cm2,peripheral artery disease, diabetic nephropathy, coronary heart disease,severe diabetic foot infection, high-sensitivity C-reactive protein(hsCRP)>5mg/L, Fibrinogen>4g/L.The most common pathogens in diabetic foot ulcers were Pseudomonas aeruginosa,Staphylococcus aureus, Staphylococcus epidermidis.18.2%patients had more than one pathogens.57.4%patients had multiple drug-resistant organisms.2.There were303(52.7%)patients with DFO,272(47.3%) patients without DFO. Multivariate nonconditional Logistic regression showed that the duration of DF>4weeks(OR=2.3,95%CI:1.4-3.7), foot ulcer history(OR=2.9,95%CI:1.5-5.5),fever(OR=2.2,95%CI:1.2-4.3),malodor(OR= 2.8,95%CI:1.7-4.6), loss of protection sensation(OR=5.0,95%CI:3.1-4.9), multiple foot ulcers(OR=2.0,95%CI:1.2-3.2), CLI(OR=2.1,95%CI:1.3-3.4), ESR>40mm/h(OR=1.7,95%CI:1.1-2.7),ALB<35g/L(OR=2.4,95%CI:1.4-4.0) and hs-CRP>5mg/L(OR=2.1,95%CI:1.3-3.5) were the risk factors for DFO.3. There were239(87.9%) DFO patients amputaed,64(12.1%) DFO patients healed without amputation. Model one included foot ulcer area>4cm2and CLI, multivariate nonconditional Logistic regression discovered that the smoking history(OR=4.6,95%CI:2.1-9.8), malodor(OR=3.1,95%CI:1.5-6.3), foot ulcer area>4cm2(OR=2.2,95%CI:1.1-4.3), CLI(OR=3.8,95%CI:1.7-8.4) and ESR>50mm/h(OR=2.4,95%CI:1.1-5.3) were the risk factors for amputation in DFO patients. Model two included S(AD)SAD score. The smoking history(OR=4.5,95%CI:2.1-9.6), malodor(OR=2.4,95%CI:1.1-5.2), S(AD)SAD score>12(OR=4.8,95%CI:2.1-11.4) were the risk factors for amputation in DFO patients.Conclusion:DFO always occurs in the diabetic patients with advanced age,long diabetic duration and foot ulcer duration, more complications, markedly elevated inflammation markers, increased rates of MDRO infections. The duration of DF>4weeks, foot ulcer history,fever,malodor, loss of protection sensation, multiple foot ulcers, CLI, ESR>40mm/h, ALB<35g/L and hs-CRP>5mg/L were the risk factors for DFO.The smoking history, malodor, S(AD)SADscore>12, foot ulcer area>4cm2, CLI and ESR>50mm/h were the risk factors for amputation in DFO patients. To shorten healing time and to improve healing rates,DF should be treated as emergency with multidisciplinary team management as soon as possible. But more importantly, attentions should be paid to the education program related to DF prevention and to early intervention of risk factors in the clinical work. Once DF was discovered, patients should go to the hospital with experience in treating this disease.