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Risk Factors Associated with Failure of Toe Amputation in Diabetic Foot Infections

Gerardo Víquez-Molina1, Javier Aragón-Sánchez2, Mariana Villalobos-Vargas3

  • 1Diabetic foot Unit, San Juan de Dios Hospital, San José, Costa Rica.

The International Journal of Lower Extremity Wounds
|October 27, 2023
PubMed

Insights

Diabetic foot infection amputation failure is common, affecting about one-third of patients. Severe infections, specific bacteria like E. coli and P. aeruginosa, and prolonged prothrombin time increase failure risk. Obesity and higher hemoglobin levels may reduce failure risk.

Area of Science:

  • Podiatry
  • Infectious Diseases
  • Endocrinology

Background:

  • Diabetic foot infections are a significant cause of morbidity and limb loss.
  • Index toe amputation is a common initial surgical intervention for moderate to severe diabetic foot infections.
  • Understanding factors predicting amputation failure is crucial for optimizing patient outcomes and preventing further surgical interventions.

Purpose of the Study:

  • To identify clinical and microbiological factors associated with the failure of index toe amputation in patients with diabetes and foot infection.
  • To determine the prevalence of amputation failure and its associated risk factors in this patient population.

Main Methods:

  • Retrospective cohort study of 175 diabetic patients hospitalized for moderate to severe foot infection who underwent index toe amputation.
  • Poisson regression model was utilized to calculate prevalence ratios (PR) and 95% confidence intervals (CI) for associated factors.
  • Multivariate analysis adjusted for age and sex was performed to identify significant predictors of amputation failure.

Main Results:

  • Approximately 30.3% of patients experienced failure after index toe amputation, necessitating more proximal surgery.
  • Significant factors associated with higher failure rates included severe infection (PR: 1.78), Escherichia coli infection (PR: 2.21), Pseudomonas aeruginosa infection (PR: 2.11), and prolonged prothrombin time (PR: 1.13).
  • Obesity (PR: 0.58) and elevated hemoglobin levels (PR: 0.92) were associated with a lower prevalence of amputation failure.

Conclusions:

  • Index toe amputation for diabetic foot infection has a substantial failure rate, highlighting the need for careful patient selection and management.
  • Infections by specific pathogens (E. coli, P. aeruginosa), severe infection presentation, and coagulopathy (prolonged prothrombin time) are key indicators of potential surgical failure.
  • Conversely, obesity and higher hemoglobin levels may confer a protective effect against amputation failure, warranting further investigation into their underlying mechanisms.

Keywords:
Escherichia coliPseudomonas aeruginosabody mass indexdiabetic footinfectionminor amputation

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