Narrow Results

The epidemiology of diabetic foot infections and the predictive factors for limb loss were evaluated in a cohort of 100 diabetics treated at the National University Hospital (NUH) during the period January to June 2005. The mean age of study population was 59.8 years. Ethnically there was a significant increased representation in Malays along with a significant decreased representation in Chinese. All had type 2 diabetes. The common infections included abscess (32%), wet gangrene (29%) and infected ulcers (19%); 13 patients were treated conservatively. The major amputation rate (below and above knee amputations) was 28%; 48% had monomicrobial and 52% polymicrobial infections. The most common pathogens in both infectious were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeroginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictivefactors for limb loss were ages about 60 years, gangrene, ABI < 0.8, monomicrobial infections, WBC ≥ 15.0 × 10⁹/L, ESR ≥ 100 mm/hr, CRP ≥ 15.0 mg/dL, Hb ≤ 10.0 g/dL and Cr ≥ 150 μmol/L. With stepwise logistic regression, only gangrene, ABI < 0.8, WBC ≥; 15.0 × 10⁹/L and Hb ≤ 10.0g/dL were significant.

Major amputation resulting from a diabetic foot problem poses not only serious emotional burden but also serious mortality issues. Indeed amputation leads to loss of life. It is therefore imperative to avoid limb loss at all costs. This requires all diabetics to undergo annual foot screening and foot care to address the “foot at risk” promptly. Several research workers have studied the role of various factors as predictive factors for limb loss. The authors compare and discuss their results in evaluating predictive factors in a cohort of 202 diabetics with those of other co-workers.

With univariate analysis, predictive factors were found to be age above 60, co-morbidities like stroke and ischaemic heart disease, complications of diabetes including nephropathy, peripheral vascular disease and sensory neuropathy HbA1C level > 7%, ankle brachial index (ABI) < 0.8, foot problems such as gangrene and infection and pathogens such as MRSA and Staphylococcus aureus. With stepwise logistic regression, only peripheral vascular disease and infection were found to be significant.