A retrospective analysis of the outcomes of treatment associated with foot infections in a cohort of hospitalised diabetic patients

Abstract

Introduction: Patients with diabetes mellitus and infected foot ulcers involving soft tissue and bone, continue to be a huge problem that challenges health professionals within multidisciplinary teams in this country and across the world. Objective: A retrospective study was designed to explore the treatment strategies and health outcomes for a cohort of hospitalized Type I and Type II diabetic patients with foot infections. It also investigated whether specific patient data / characteristics present at admission to hospital were associated with the treatment outcome. Methods: One hundred and twenty eight medical records were studied. Variables included patient demographics, assessment findings on admission, treatment details and health outcomes. The majority of patient wounds’ were classified as moderate to severe (potentially limb threatening) according to Grayson’s (1995) model and these wounds were mainly contaminated with polymicrobial species. Results: Combination antibiotic therapy was the favoured course of treatment. Surgical intervention included angioplasty, debridement and amputations. Most patients were discharged with unhealed wounds into the community. The mean time for healing following discharge was just over 3 months. Of the patients whose wounds had healed within 1 year of treatment, 11 patients were readmitted for a new diabetic foot infection(s). Using predetermined criteria, 73% patients were deemed as having poor treatment outcomes. Conclusion: Using Logistical Regression, the strongest association that may act as predictors for a poor treatment outcome, and may be used in future studies, was that of wound infection severity classification (p=0.003) and ischaemia (p=0.021) at entry to hospital.

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