Ndosi, M orcid.org/0000-0002-7764-3173, Wright-Hughes, A orcid.org/0000-0001-8839-6756, Brown, S orcid.org/0000-0002-1840-3786 et al. (8 more authors) (2018) Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study. Diabetic Medicine, 35 (1). pp. 78-88. ISSN 0742-3071
Abstract
Aims: To determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer. Methods: This multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence. Results: In the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06). Conclusions: Clinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/ |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Healthcare (Leeds) > Nursing Adult (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research 006/725 NIHR National Inst Health Research 09/75 |
Depositing User: | Symplectic Publications |
Date Deposited: | 06 Dec 2017 11:27 |
Last Modified: | 29 Mar 2018 10:59 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/dme.13537 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:124829 |
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