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Differences in Foot Infections Secondary to Puncture Wounds or Chronic Ulcers in Diabetes
Gerardo Víquez-Molina1, Javier Aragón-Sánchez2, María Eugenia López-Valverde3
1Diabetic Foot Unit, San Juan de Dios Hospital, San José de Costa Rica, Costa Rica.
Abstract:
We hypothesized that foot infections secondary to a puncture wounds (PWs) have a worse prognosis concerning infection-related mortality, recurrence of the infection, and healing than those secondary to a chronic ulcer. We conducted a prospective study consisting of 200 patients with moderate-to-severe diabetic foot infections. The cohort consisted of 155 men (77.5%) and 45 women (22.5%). The mean age of the patients was 59 years (standard deviation 12.2). Puncture wounds were the cause of the infection in 107 patients (53.5%) and a chronic ulcer was the cause in 93 patients (46.5%). One hundred and eleven patients (55.5%) had moderate and 89 (44.5%) had severe infections. Osteomyelitis was more frequently found in chronic ulcers (71%) than in PWs (44.9%), P < .001. Cox's survival analysis using PWs as an explanatory variable showed no association with infection-related mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.32-3.46, P = .92), time to recurrence of infection (HR 0.64, 95% CI 0.27-1.51, P = .30), and time to healing (HR 0.81, 95% CI 0.60-1.08, P = .15). More than half of our patients had PWs as the mechanism by which the infection occurred. These patients usually had a lower rate of osteomyelitis but required hospitalization and antibiotic therapy more frequently than patients with infected chronic ulcers. We found no difference in outcomes between the 2 groups.
Insights
Diabetic foot infections from puncture wounds (PWs) and chronic ulcers have similar outcomes. While PWs were more common and less likely to cause osteomyelitis, both infection types required hospitalization and antibiotics, with no significant difference in mortality or healing.
Area of Science:
- Podiatry
- Infectious Diseases
- Diabetology
Background:
- Diabetic foot infections pose significant health risks.
- Understanding the etiological factors influencing infection outcomes is crucial for effective management.
- Puncture wounds (PWs) and chronic ulcers represent distinct mechanisms of diabetic foot infection.
Purpose of the Study:
- To compare the prognosis of diabetic foot infections secondary to puncture wounds versus chronic ulcers.
- To evaluate differences in infection-related mortality, recurrence, and healing between the two etiologies.
- To investigate the association of puncture wounds with osteomyelitis development.
Main Methods:
- Prospective study of 200 patients with moderate-to-severe diabetic foot infections.
- Categorization of infections based on etiology: puncture wounds (PWs) or chronic ulcers.
- Utilized Cox's survival analysis to assess outcomes including mortality, recurrence, and healing.
Main Results:
- Puncture wounds caused infection in 53.5% of patients; chronic ulcers in 46.5%.
- Osteomyelitis was significantly more frequent in chronic ulcers (71%) than in PWs (44.9%), P < .001.
- No significant differences were found in infection-related mortality (HR 1.06), time to recurrence (HR 0.64), or time to healing (HR 0.81) between PWs and chronic ulcers.
Conclusions:
- Diabetic foot infections stemming from puncture wounds and chronic ulcers exhibit comparable prognoses regarding mortality, recurrence, and healing.
- Puncture wounds, though more common and associated with less osteomyelitis, necessitate similar clinical management intensity as chronic ulcers.
- The study highlights the importance of considering diverse etiologies in diabetic foot infections and managing them with comparable vigilance.
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