The infected diabetic foot: Bacteraemia and endocarditis complicating moderate and severe foot infections

To identify the incidence of blood stream infections (BSIs) and endocarditis in patients with diabetic foot infections (DFIs), risk factors and clinical outcomes. A post hoc analysis of 280 patients using pooled patient level data from three RTCs. Blood cultures were drawn at time of admission for DFI. Deep intraoperative cultures were obtained from infected foot wounds. Data from the 12-month follow-up were used to determine clinical outcomes. 77.1% (N = 216) had blood cultures of which 15.7% (n = 34) had BSI. One patient (3.3%) had endocarditis. Risk factors for BSI included Charcot Neuroarthropathy history (20.6% vs. 7.1%, p = 0.03), low systolic blood pressure (128.3 ± 21.0 vs. 140.8 ± 22.2 p = 0.003), low diastolic blood pressure (71.6 ± 9.4 vs. 79.3 ± 11.5 p <0.001), leucocytosis >12 000 (55.9% vs. 29.1%, p = 0.002) and elevated C-reactive protein (CRP) (26.8 ± 31.2 vs. 12.0 ± 19.6, p <0.001). During the index hospitalization, BSI patients had longer median hospitalizations (14.0, 11.3-18.0 vs. 12.0, 9.0-16.0, p = 0.04). At 12-months, BSI patients were more likely to be admitted to the hospital (all cause hospital admissions 35.3% vs. 18.6%, p = 0.03). There was no difference in re-infection (20.6% vs. 32.9%, p = 0.21), foot-specific hospitalizations (17.6% vs. 22.5%, p = 0.65), wounds healing (64.7% vs. 67.5%, p = 0.88), time to heal (221.0, 74.0-365 vs. 109.5, 46.8-365, p = 0.16) or antibiotic duration (46.0, 39.3-76.5 vs. 45.0, 22.3-67.0, p = 0.09). The most common BSI pathogens were Staphylococcus aureus (79.4%) and Streptococcus spp. (50.0%) species. BSI is common in DFIs. Patients have longer hospitalizations and were more likely to be hospitalized after their initial discharge.