Characterization of pathogenic microorganisms in diabetic foot infections and development of a risk prediction model
Shufang Yan1, Xuemeng Zhu1, Tong Yu1
1Department of Endocrinology, Henan University Huaihe Hospital, Kaifeng, 475500, Henan, China.
Abstract:
This study aimed to investigate the distribution of pathogenic microorganisms in diabetic foot infections (DFIs) and develop a nomogram to predict DFIs. It included 136 diabetic foot (DF) patients hospitalized at Henan University Huaihe Hospital from November 2020 to November 2024, with 86 (63.23%) having confirmed infections. Infections were predominantly caused by Gram-positive cocci (54.65%) and Gram-negative bacilli (43.02%). The nomogram incorporated age, C-reactive protein (CRP), Wagner grade, lower extremity arterial disease (LEAD), and peripheral neuropathy (PN). The predictive model exhibited robust discriminatory capacity, achieving an area under the curve (AUC) of 0.803 (95% confidence interval (CI) 0.735-0.878) with internal cross-validation stability (AUC = 0.804). Goodness-of-fit was confirmed by the Hosmer-Lemeshow test (χ2 = 5.014, p = 0.756), with excellent net benefit shown by decision curve analysis. Our findings indicate a high infection rate in DF patients, mainly caused by Gram-positive cocci. The nomogram incorporating age, CRP, Wagner grade, LEAD, and PN parameters enables rapid DFIs screening, facilitating timely antibiotic initiation through early infection detection to enhance clinical management.
Insights
Diabetic foot infections (DFIs) are common, primarily caused by Gram-positive cocci. A new nomogram using age, C-reactive protein, Wagner grade, lower extremity arterial disease, and peripheral neuropathy aids in early DFI detection and management.
Area of Science:
- Microbiology
- Clinical Medicine
- Biostatistics
Background:
- Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus.
- Accurate identification of causative pathogens and early prediction of DFIs are crucial for effective treatment.
Purpose of the Study:
- To determine the distribution of pathogenic microorganisms in DFIs.
- To develop and validate a predictive nomogram for DFIs.
Main Methods:
- Retrospective analysis of 136 diabetic foot patients.
- Microbiological analysis of infection samples.
- Development and validation of a nomogram incorporating clinical and laboratory parameters (age, CRP, Wagner grade, LEAD, PN).
Main Results:
- A high infection rate (63.23%) was observed in the study cohort.
- Gram-positive cocci (54.65%) were the predominant pathogens, followed by Gram-negative bacilli (43.02%).
- The developed nomogram demonstrated robust predictive accuracy (AUC = 0.803) and good fit.
Conclusions:
- Gram-positive cocci are the main cause of DFIs.
- The validated nomogram provides a reliable tool for early DFI screening.
- Timely detection facilitates prompt antibiotic therapy, improving clinical outcomes in diabetic foot patients.
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