Nearly 1 in 7 patients die in first year with infected diabetic foot ulcer

Outcomes are worse than previously thought for people with a clinically infected diabetic foot ulcer, UK researchers recently reported in Diabetic Medicine. In the first year of an infected foot ulcer, nearly one in seven patients (15.1%) died, one in six (17.4%) underwent at least partial amputation of the foot, and fewer than half (45.5%) achieved full healing of their ulcer.

These findings highlight the need for close monitoring and early intervention in patients with diabetic foot ulcers, the researchers advised.

“The key point is that people need to be seen quickly if an ulcer begins to form—that gives health workers the greatest chance of trying to treat the condition,” said study leader Andrea Nelson, PhD, BSc(Hons), RGN, professor in the School of Healthcare at University of Leeds, Leeds, UK.

For this study, Dr. Nelson and colleagues reviewed case notes on a UK-representative sample of 299 patients with an infected foot ulcer who had attended a diabetes clinic. In 136 patients (45.5%), ulcers healed in a median of 4.5 months (range 0.5-12.9). But the ulcer recurred in 13 patients (9.6%) at a median of 1.7 months (0.3-10.7) after healing.

The incidence of healing was higher if the patient had only one ulcer on the foot (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.18-3.06) or if coagulase-negative staphylococci were identified from the ulcer culture (HR: 1.53, 95% CI: 0.98-2.40).

The incidence of healing was lower if the ulcer had a PEDIS (perfusion, extent, depth, infection, sensation) grade of 2 or higher (HR: 0.37, 95% CI: 0.25-0.55) or had lasted 2 months or longer (HR: 0.55, 95% CI: 0.39-0.77).

Lower extremity amputation occurred in 52 patients (17.4%), and 18 (6.0%) had revascularization surgery.

Unlike other studies, this investigation found no significant association between the incidence of healing and prognostic factors such as glycemic control, duration of diabetes, ulcer site, sex, wound area, or wound depth.

“The results of our study should help clinicians caring for patients with diabetes to identify those most at risk of poor outcomes so that we can look to provide further support,” said podiatrist Michael Backhouse, PhD, BSc(Hons), one of the study’s authors and a senior research fellow at the University of Leeds.

This research was funded by the UK’s National Institute for Health Research.