Deep foot infections in patients with diabetes and foot ulcer: An entity with different characteristics, treatments, and prognosis

We report findings in 223 consecutively included people with diabetes, foot ulcer and a deep foot infection treated by a multidisciplinary diabetic fo ot care team at the University Hospital in Lund, Sweden. The aim of the pre sent study was to evaluate type and characteristics of deep foot infections and their relation to choice of treatment and outcome. Three different gro ups of deep foot infections were identified; osteomyelitis only (n = 112), deep soft tissue infection only (n = 46) and combined infections (osteomyel itis and deep soft tissue infection, n = 65). The various types of deep foo t infections had different characteristics, treatment and prognosis. Patien ts with a deep soft tissue infection only or a combined infection had a sig nificantly (p < 0.05) higher; (1) body temperature (38.0 and 38.0 vs. 37.3 degrees C), (2) erythrocyte sedimentation rate (75 and 80 vs. 56 mm/h) and (3) white blood count (11.0 and 12.0 vs. 8 x 10(9)) at diagnosis compared w ith those who had osteomyelitis only. Patients with a deep soft tissue infe ction only or a combined infection also had a significantly (p < 0.05) shor ter time to surgery (2 and 4 vs. 10 days), higher mean number of surgical p rocedures (1.9 and 2.2 vs. 1.4 procedures) and higher percentage of patient s had intravenous antibiotics (87 and 84 vs. 46%) compared with those who h ad osteomyelitis only. Amputation before healing was more common in patient s with a combined infection (62%) compared with those who had osteomyelitis only (37%) or a deep soft tissue infection only (30%). The findings in the present study indicate that deep foot infections in patients with diabetes is a heterogeneous entity, in which the type of deep foot infection is rel ated to choice of treatment strategy and to outcome. Therefore, these vario us types of infections has to be considered in future studies of deep foot infections in people with diabetes, (C) 2000 Elsevier Science Inc.