CLINICAL CHARACTERISTICS AND OUTCOME IN 223 DIABETIC-PATIENTS WITH DEEP FOOT INFECTIONS

Clinical characteristics and outcome in 223 consecutive diabetic patie nts with deep foot infections are reported. Patients were treated by a multidisciplinary diabetic foot-care team at the University Hospital, Lund, Sweden, and were prospectively followed until healing or death. About 50% of patients lacked clinical signs of infection, such as a b ody temperature > 37.8 degrees C, a sedimentation rate > 70 mm/hour, a nd white blood cell count (WBC) > 10 x 10(9)/liter. Eighty-six percent had surgery before healing or death. Thirty-nine percent healed witho ut amputation; 34% healed after a minor and 8% after a major amputatio n. Sixteen percent were unhealed at death, and 3% were unhealed at the end of the observation period. Of those unhealed at death or follow-u p, 4 patients had had a major and 11 a minor amputation. After correct ion for age and sex, duration of diabetes < 14 years, palpable poplite al pulse, a toe pressure > 45 mmHg, and an ankle pressure > 80 mm Hg, absence of exposed bone and a white blood cell count < 12 x 10(9)/lite r were all related to healing without amputation in a logistic regress ion analysis. We conclude that although only 1 in 10 had a major amput ation, nearly all diabetic patients with a deep foot infection needed surgery and more than one third had a minor amputation before healing or death in spite of a well-functioning diabetic foot-care team respon sible for all included patients.