The final study population comprised patients Appendix A , and their demographic and clinical characteristics are presented in Table 1. Eight wounds were initially classified as non-infected stage A by the investigators but, after reviewing the data, the steering committee decided to reclassify four of the wounds from stage A to stage B, and four other wounds from stage C to stage D, as a consequence of an obvious coding error.
Peripheral pulses were examined in patients: ABPI was measured in only 98 patients: As a whole, samples were obtained but, for technical reasons, 27 were not usable. As shown in Appendix A , off-loading the wound was applied in nearly all cases, and bedside debridement was frequently done. Median duration of parenteral therapy alone or associated with oral administration was Median hospital length of stay LOS was three weeks first—third percentiles: Two patients underwent a second amputation on the contralateral limb, and two others on the ipsilateral limb at a more proximal level.
Thus, the outcome was considered unfavourable in patients, and a history of previous amputation together with infection was associated with the poorest outcomes Appendix A.
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LOS was longer in amputated 3. No deaths were related to the infectious process itself. During the period between discharge and consultation, 18 patients died and 21 were lost to follow-up. Multivariate analysis showed that the risk of amputation during hospitalization and within the year following hospitalization was increased independently when: On the other hand, debridement and conservative surgery during hospitalization lowered the risk of amputation.
However, neither the presence of S. Detailed results are presented in Appendix A. The aim of the present study was two-fold: For this reason, it seemed logical to compare the procedures usually performed in French centres with those recommended by the SPILF. Validation of a diabetic wound classification system. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe.
Recommandations pour la pratique clinique. Yet, few studies have been published on the evaluation of DFI and, as far as the present authors are aware, only one retrospective review was conducted in an inpatient setting — and emphasized the lack of detailed of lower-extremity examination. Anatomic location of acute diabetic foot infection.
Foot infections in diabetes DFIs in the outpatient setting: This may be explained by the fact that the present study included only hospitalized patients, whose infection was probably more severe than those seen in an outpatients setting. As regards to bacteriology, S. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: French national program for prevention of healthcare-associated infections and antimicrobial resistance, The diabetic foot clinic: The present study also showed that improved microbiological sampling is essential, as per the national and international recommendations for DFI.
In addition, superficial swabs must not be used, as these fail to isolate aerobic bacteria and promote the isolation of colonizing flora. Indeed, the present data show that there is still much progress to be made even at specialized centres, as more than half of samples were obtained by swabbing the wound. The misuse of this sampling technique leads to lower isolation rates of the true pathogens. However, the number of different protocols in use is still too large. It is also worth noting the relatively high rate of pristinamycin prescription.
This member of the streptogramin family is only marketed in some European countries, and has the advantages of an oral route, penetration into bone tissue and activity against multidrug-resistant S. Prediction of outcome in individuals with diabetic foot ulcers: The present study showed that the overall outcome for diabetic patients hospitalized for an infected foot wound remains poor even at specialized centres.
DFIs are often polymicrobial, although S. DFIs are often complicated by osteomyelitis, which makes treatment more difficult, while increasing the risk of lower-limb amputation. As a whole, however, the recommended guidelines have been put into practice at these centres, except for deep wound sampling and systematic screening for PAD. Although PAD appears to be a major factor associated with a poor outcome and amputation in patients with DFI, it is often overlooked. Baleydier is a paid employee of RCTs, the company in charge of managing the study.
The corresponding author J.
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Le pied diabétique, mécanismes physiopathologiques et épidémiologie - EM|consulte
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