Diabetic Extremity Infections

ABSTRACT
Extremity infections, especially the lower extremity infections, are the most common complication and cause of admittance to hospital in people with diabetes mellitus. The rate of lower March amputation is 40 times higher in diabetic patients compared with non-diabetics. The records of 101 diabetic patients hospitalized for diabetic extremity infection between April 1993 and March 1996 were reviewed retrospectively. Here, the data of 80 patients that we were able to obtain completely will be discussed. Mean age of patients was 61.02±11.43 years (26-84 years). Mean body mass index was 25.43±5.01 kg/m2 (16.71-34.19). Seventy-nine patients had type II diabetes mellitus (DM), and 1 patient had type l DM. Mean duration of DM was 13.29±9.31 (0-40) years. Thirty-five (44%) patients had peripheral vascular disease, Fifty-five (70%) patients had diabetic retinopathy. Twenty-three (29%) patients had nephropathy. Fifty-eight (73%) patients had peripheric polyneuropathy. Twenty-eight (35%) patients had autonomous neuropathy. Twenty-eight (35%) patients had hypertension. Osteomyelitis was diagnosed in 32 (40%) patients with direct radiography or by other methods (MRI, scintigrapy). There was only soft-tissue tnfection in 48 (60%) patients. The mean period between the first day of diabetic extremity wound and admittance to hospital was 57.45±67.55 days (0-365). Amputation was performed in 13 patients (16%). Eighteen aspiration cultures were positive (23%). The most common microorganism was Staphylococcus aureus (33%). Antibiotic therapy and hospitalization duration were significantly longer in patients with osteomyelitis than in patients with soft tissue infection (30.62±10.64 versus 20.63±12.74 days, 49.88±43.22 versus 34.28±17.99 days respectively) (p<0,05). Mortality, morbidity and therapy cost in diabetic patients with extremity infections are too high. Prevention and early diagnosis are the mainstays for managing these patients.