ObjectiveTo compare pathogens involved in skin and soft tissue infection (SSTI) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. MethodsWe evaluated 113 consecutive patients between June 2011 and March 2019 with foot infection (SSTI and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes (DM) and 30 did not (NDM). We evaluated the bacterial pathogens in patients with skin and soft tissue infections (SSTI) and pedal osteomyelitis (OM). ResultsPolymicrobial infection were more common in patients with diabetes mellitus (83.1% vs 53.3%, p=.001). The most common pathogen for SSTI and OM in DM was s. aureus (SSTI 50.7%, OM 32.3%), whereas in NDM patients it was Pseudomonas (25%) for SSTI. Anaerobes (9.4%) and fungal (3.1%) infection were uncommon. Pseudomonas aeruginosa was only identified in 5.8% of people with diabetes. ConclusionsThe most common bacterial pathogen in both SSTIs and pedal OM was staphylococcus aureus in patients with DM. Pseudomonas spp., was the most common pathogen in people without diabetes with SSTIs.
BACKGROUND: Multiple organizations have issued guidelines to address the prevention, diagnosis and management of diabetic foot ulcers. These guidelines are based on evidence review and expert opinion. <p>METHODS: Literature review was conducted and guidelines were reviewed to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations and the level of evidence.</p> <p>RESULTS: Most guidelines were not based on highest level of evidence (randomized controlled trials). A listing of recommendations for prevention, diagnosis and management was created with evidence basis for all recommendations.</p> <p>CONCLUSIONS: Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or in areas of clinical care without recommendations.</p>
Drug based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence, and reduction of spread for superficial fungal mycoses. The goal of this review was to examine the available methods of sanitization for footwear and textiles against superficial fungal infections. A systematic literature search of various sanitization devices and methods that could be applied to footwear and textiles using PubMed, Scopus, and MEDLINE was performed. Fifty-four studies were found relevant to the different methodologies, devices, and techniques of sanitization as it pertains to superficial fungal infections of the feet. These included topics of basic sanitization, antifungal and antimicrobial materials, sanitization chemicals and powder, laundering, ultraviolet, ozone, non-thermal plasma, microwave radiation, essential oils, and natural plant extracts. In management of onychomycosis it is necessary to think beyond treatment of the nail, as infections enter through the skin. Those prone to onychomycosis should examine their environment, including surfaces, shoes, and socks, and ensure that proper sanitization is implemented.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following open lower extremity bypass surgery in subjects with diabetes mellitus with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with CPT codes 35533, 35540, 35556, 35558, 35565, 35566, 35570 and 35571 and with the diagnosis of diabetes mellitus. This resulted in 83 subjects ≤60 inches, 1084 subjects >60 inches and <72 inches, and 211 subjects ≥72 inches.
Results: No differences were observed between groups with respect to the development of a superficial surgical site infection (9.6% vs. vs. 6.4% vs. 5.7%; p=0.458), deep incisional infection (1.2% vs. 1.4% vs. 2.8%; p=0.289), sepsis (2.4% vs. 2.0% vs. 2.8%; p=0.751), unplanned reoperation (19.3% vs. 15.6% vs. 21.8%; p=0.071), nor unplanned hospital readmission (19.3% vs. 14.8% vs. 17.1%; p=0.573). A significant difference was observed between groups with respect to the development of a wound disruption (4.8% vs. 1.3% vs. 4.7%; p=0.001). A multivariate regression analysis was performed of the wound disruption outcome with the age, gender, race, ethnicity, height, weight, current smoker and open wound/wound infection variables. Race (p=0.025) and weight (p=0.003) were found to be independently associated with wound disruption, but height was not (p=0.701).
Conclusions: The results of this investigation demonstrate no significant difference in short-term adverse outcomes following the performance of lower extremity bypass surgery based on patient height.
Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. Methods: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed.Results: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group.Conclusions: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248
Background: The objective of this investigation was to evaluate adverse short-term outcomes following partial forefoot amputation with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with a 28805 CPT code (amputation, foot; transmetatarsal) that underwent the procedure with “all layers of incision (deep and superficial) fully closed.” This resulted in 11 subjects with a height ≤60 inches, 202 subjects with a height >60 inches and <72 inches, and 55 subjects ≥72 inches.
Results: Results of the primary outcome measures found no significant differences between groups with respect to the development of a superficial surgical site infection (0.0% vs. 6.4% vs. 5.5%; p=0.669), deep incisional infection (9.1% vs. 3.5% vs. 10.9%; p=0.076), or wound disruption (0.0% vs. 5.4% vs. 5.5%; p=0.730). Additionally, no significant differences were observed between groups with respect to unplanned reoperations (9.1% vs. 16.8% vs. 12.7%; p=0.0630) or unplanned hospital readmissions (45.5% vs. 23.3% vs. 20.0%; p=0.190).
Conclusions: The results of this investigation demonstrate no difference in short-term adverse outcomes following the performance of partial forefoot amputation with primary closure based on subject height. Although height has previously been described as a potential risk factor in the development of lower extremity pathogenesis, this finding was not observed in this study from a large US database.
The COVID-19 pandemic is driving significant change in the healthcare system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, ER visits, hospitalizations, length-of-stay, and costs. But podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the COVID-19 risk. The goal of podiatrists during the pandemic is to reduce the burden on the healthcare system by keeping diabetic foot and wound patients safe, functional, and at home.