• 1.

    Hick JL, Hanfling D, Wynia MK, et al: Crisis standards of care and COVID-19: what did we learn? How do we ensure equity? What should we do? NAM Perspect 2021: 2021, .

  • 2.

    Godlee F: Surviving the long road ahead. BMJ 369: m1840, 2020.

  • 3.

    Zhou Y, Chi J, Lv W, et al: Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev 37: e3377, 2021.

  • 4.

    Rogers LC, Lavery LA, Joseph WS, et al: All feet on deck: the role of podiatry during the COVID-19 pandemic: preventing hospitalizations in an overburdened healthcare system, reducing amputation and death in people with diabetes. JAPMA 113: 20-051, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Monteiro-Soares M, Russell D, Boyko EJ, et al: Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev 36 (suppl 1): e3273, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Berendt AR, Peters EJ, Bakker K, et al: Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev 24 (suppl 1): S145, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Casciato DJ, Yancovitz S, Thompson J, et al: Diabetes-related major and minor amputation risk increased during the COVID-19 pandemic. JAPMA 113: 20-224, 2023.

  • 8.

    Liu C, You J, Zhu W, et al: The COVID-19 outbreak negatively affects the delivery of care for patients with diabetic foot ulcers. Diabetes Care 43: e125, 2020.

  • 9.

    Caruso P, Longo M, Signoriello S, et al: Diabetic foot problems during the COVID-19 pandemic in a tertiary care center: the emergency among the emergencies. Diabetes Care 43: e123, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Viswanathan V, Nachimuthu S: Major lower-limb amputation during the COVID pandemic in South India. Int J Low Extrem Wounds 22: 475, 2023.

  • 11.

    Miranda JA, Chung J, Mills JL: Influence of the COVID-19 pandemic on the management of chronic limb-threatening ischemia. Semin Vasc Surg 34: 89, 2021.

  • 12.

    de Mestral C, Gomez D, Wilton AS, et al: A population-based analysis of diabetes-related care measures, foot complications, and amputation during the COVID-19 pandemic in Ontario, Canada. JAMA Netw Open 5: e2142354, 2022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ilonzo N, Koleilat I, Prakash V, et al: The effect of COVID-19 on training and case volume of vascular surgery trainees. Vasc Endovascular Surg 55: 429, 2021.

  • 14.

    Schuivens PME, Buijs M, Boonman-de Winter L, et al: Impact of the COVID-19 lockdown strategy on vascular surgery practice: more major amputations than usual. Ann Vasc Surg 69: 74, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Lipscomb D, Smith AS, Adamson S, et al: Diabetic foot ulceration in COVID-19 lockdown: cause for concern or unexpected benefit? Diabet Med 37: 1409, 2020.

Impact of the COVID-19 Pandemic on Diabetic Foot Patients: A Shift in the Infectious Agent Profile Toward Nonfermentative Gram-Negative Bacilli

Ali Acar Department of Medical Microbiology, Atılım University School of Medicine, Ankara, Turkey.
Bayındır Healthcare Group, Infectious Diseases Clinic, Sogutozu Hospital, Ankara, Turkey.

Search for other papers by Ali Acar in
Current site
Google Scholar
PubMed
Close
 MD
,
Neşe Saltoğlu Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

Search for other papers by Neşe Saltoğlu in
Current site
Google Scholar
PubMed
Close
 MD
,
Necla Tülek Department of Medical Microbiology, Atılım University School of Medicine, Ankara, Turkey.

Search for other papers by Necla Tülek in
Current site
Google Scholar
PubMed
Close
 MD
,
Özge Turhan Department of Infectious Diseases and Clinical Microbiology, Akdeniz University School of

Search for other papers by Özge Turhan in
Current site
Google Scholar
PubMed
Close
 MD
,
Elif Nazlı Serin Department of Endocrinology, Akdeniz University School of Medicine, Antalya, Turkey

Search for other papers by Elif Nazlı Serin in
Current site
Google Scholar
PubMed
Close
 MD
,
Derya Yapar Department of Infectious Diseases and Clinical Microbiology, Hitit University School of Medicine, Ulukavak, Çorum, Turkey.

Search for other papers by Derya Yapar in
Current site
Google Scholar
PubMed
Close
 MD
,
Murat Kendirci Department of General Surgery, Hitit University School of Medicine, Ulukavak, Çorum, Turkey.

Search for other papers by Murat Kendirci in
Current site
Google Scholar
PubMed
Close
 MD
,
Serkan Sürme Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

Search for other papers by Serkan Sürme in
Current site
Google Scholar
PubMed
Close
 MD
,
Banu Yıldız Karaca Department of Infectious Diseases and Clinical Microbiology, İzmir Katip Çelebi University Faculty of Medicine, Çiğli, İzmir, Turkey.

Search for other papers by Banu Yıldız Karaca in
Current site
Google Scholar
PubMed
Close
 MD
,
Fatma Aybala Altay Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, Ankara, Turkey

Search for other papers by Fatma Aybala Altay in
Current site
Google Scholar
PubMed
Close
 MD
,
Rıdvan Tayşi Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, Ankara, Turkey

Search for other papers by Rıdvan Tayşi in
Current site
Google Scholar
PubMed
Close
 MD
,
İrfan Şencan Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, Ankara, Turkey

Search for other papers by İrfan Şencan in
Current site
Google Scholar
PubMed
Close
 MD
,
Esra Tanyel Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Faculty of Medicine, Atakum, Samsun, Turkey.

Search for other papers by Esra Tanyel in
Current site
Google Scholar
PubMed
Close
 MD
,
Heval Can Bilek Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Faculty of Medicine, Atakum, Samsun, Turkey.

Search for other papers by Heval Can Bilek in
Current site
Google Scholar
PubMed
Close
 MD
,
Özlem Güler Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey.

Search for other papers by Özlem Güler in
Current site
Google Scholar
PubMed
Close
 MD
,
Birsen Mutlu Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Kocaeli University, İzmit, Kocaeli, Turkey.

Search for other papers by Birsen Mutlu in
Current site
Google Scholar
PubMed
Close
 MD
,
Tolga Aksan Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Kadıköy, İstanbul, Turkey.

Search for other papers by Tolga Aksan in
Current site
Google Scholar
PubMed
Close
 MD
,
Fatma Yılmaz Karadağ Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Kadıköy, İstanbul, Turkey.

Search for other papers by Fatma Yılmaz Karadağ in
Current site
Google Scholar
PubMed
Close
 MD
,
Ayten Kadanalı Department of Infectious Diseases and Clinical Microbiology, Biruni University, Medical School, Zeytinburnu, İstanbul, Turkey
Department of Infectious Diseases and Clinical Microbiology, Istanbul Umraniye Training and Research Hospital, Ümraniye, İstanbul, Turkey.

Search for other papers by Ayten Kadanalı in
Current site
Google Scholar
PubMed
Close
 MD
,
Lütfiye Nilsun Altunal Department of Infectious Diseases and Clinical Microbiology, Istanbul Umraniye Training and Research Hospital, Ümraniye, İstanbul, Turkey.

Search for other papers by Lütfiye Nilsun Altunal in
Current site
Google Scholar
PubMed
Close
 MD
,
Moumperra Chral Oglu Department of Infectious Diseases and Clinical Microbiology, Biruni University, Medical School, Zeytinburnu, İstanbul, Turkey

Search for other papers by Moumperra Chral Oglu in
Current site
Google Scholar
PubMed
Close
 MD
,
Seniha Şenbayrak Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey.

Search for other papers by Seniha Şenbayrak in
Current site
Google Scholar
PubMed
Close
 MD
,
Serpil Erol Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey.

Search for other papers by Serpil Erol in
Current site
Google Scholar
PubMed
Close
 MD
,
Öznur Ak Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kütahya Health Sciences University, Zafertepe, Kütahya, Turkey.

Search for other papers by Öznur Ak in
Current site
Google Scholar
PubMed
Close
 MD
,
Nazire Aladağ Department of Internal Medicine, Health Sciences University, Kartal Dr. Lütfi Kirdar Training and Research Hospital, Kartal, İstanbul, Turkey.

Search for other papers by Nazire Aladağ in
Current site
Google Scholar
PubMed
Close
 MD
,
Neşe Demirtürk Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Afyon Saglik Bilimleri University, Afyon, Turkey.

Search for other papers by Neşe Demirtürk in
Current site
Google Scholar
PubMed
Close
 MD
,
Petek Konya Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Afyon Saglik Bilimleri University, Afyon, Turkey.

Search for other papers by Petek Konya in
Current site
Google Scholar
PubMed
Close
 MD
,
Dilek Bulut Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Edremit, Van, Turkey.

Search for other papers by Dilek Bulut in
Current site
Google Scholar
PubMed
Close
 MD
,
Derya Öztürk Engin Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey

Search for other papers by Derya Öztürk Engin in
Current site
Google Scholar
PubMed
Close
 MD
,
Hasan Murat Aslan Department of Cardiac Surgery, Fatih Sultan Mehmet Training and Research Hospital, Ataşehir, İstanbul, Turkey

Search for other papers by Hasan Murat Aslan in
Current site
Google Scholar
PubMed
Close
 MD
, and
Sibel Doğan Kaya Department of Infectious Diseases and Clinical Microbiology, Koşuyolu High Specialization Education and Research Hospital, Kartal, İstanbul, Turkey.

Search for other papers by Sibel Doğan Kaya in
Current site
Google Scholar
PubMed
Close
 MD

Background: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality.

Methods: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]).

Results: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP.

Conclusions: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

Corresponding author: Ali Acar, MD, Medical Faculty, Atilim University, Kızılcaşar, İncek, Ankara 06830, Turkey. (E-mail: ali.acar@atilim.edu.tr; dracarali@gmail.com)
Save