Diabetic Foot Infection: Exploratory Analysis of Its Clinical Profile, Microbiology, and Outcomes.

Gram-positive cocci predominated in patients without prior amputation, while Gram-negative bacilli were significantly more common in those with prior amputations.

• Gram-positive cocci (GPC) accounted for 93.4% of isolates in patients without prior amputation
• Gram-negative bacilli (GNB) were present in 52% of patients with prior amputations
• The difference in GNB prevalence between groups was statistically significant (p= 0.03)
• Study included 126 randomly selected patients from 272 with positive intraoperative cultures out of 516 total DFI patients

Previously amputated patients showed substantially higher antimicrobial resistance to multiple antibiotic classes.

• Higher resistance to third-generation cephalosporins was detected (OR 17.6) in previously amputated patients
• Higher resistance to piperacillin-tazobactam was detected (OR 8.8) in previously amputated patients
• Higher resistance to sulbactam-ampicillin was detected (OR 6) in previously amputated patients
• Microbiological follow-up in new admissions indicated an increasing proportion of GNB with a higher proportion of antimicrobial resistance to first- or second-line compounds

The study population presented with predominantly localized infections with minimal systemic repercussion and most had Wagner stage ≥3 lesions.

• Mean patient age was 61.8 years
• Most patients presented with localized infections with minimal inflammatory or systemic repercussion
• Only one patient required ICU admission
• Most patients presented with Wagner stage ≥3 diabetic foot infections

The amputation rate was high and hospital stays were prolonged, with a majority of patients requiring rehospitalization within one year.

• 85.7% of patients underwent amputations
• Median hospital stay was 14 days
• 54% (n=68) of patients required at least one rehospitalization within the first year

Overall mortality during follow-up was substantial, but few deaths were directly attributable to diabetic foot infection.

• Patients were followed for a median of 33 months
• 47 patients (37.3%) died during the follow-up period
• Only 5 out of 47 deaths (10.6%) were directly or indirectly caused by DFI
• Median overall survival was 60 months

Multivariate logistic regression identified amaurosis, heart failure, and age as independent predictors of mortality.

• Three independent mortality predictors were identified: amaurosis, heart failure, and age
• These predictors are linked to diabetes mellitus and its comorbidities rather than to the infection itself
• Mortality was not significantly associated with the infection but to other factors linked to DM