A Diabetic Emergency One Million Feet Long: Disparities and Burdens of Illness among Diabetic Foot Ulcer Cases within Emergency Departments in the United States, 2006–2010

Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.

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Vehicle ergonomics contributing to a diabetic foot ulcer

Clinical Diabetes and Endocrinology ◽

10.1186/s40842-019-0089-4 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Christine Jarocki ◽

Brian M. Schmidt ◽

Crystal Murray Holmes

Keyword(s):

Diabetic Foot ◽

Case Reports ◽

Treatment Plan ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

The United States ◽

Foot Ulcers ◽

Etiologic Factor ◽

Diabetic Foot Ulcers ◽

First Case

Abstract Background Diabetes mellitus continues to be a rising concern in the United States. It affects an estimated 9.4% of the population and approximately 1.5 million Americans are diagnosed annually. Approximately 85% of diabetic foot ulcers are associated with diabetic peripheral neuropathy and an infected diabetic foot ulcer is often the first sign of diabetes. There are countless studies within the literature that investigate how insensate feet and the manifestation of a foot ulcer further decrease quality of life and increase risk for mortality. Literature focuses on gait and kinematics that contribute to the formation of a diabetic foot ulcer. While pressure and shear forces are etiologic factors that may lead to the formation of diabetic foot ulcers, the position of the foot while driving an automobile has been ignored as a possible risk factor. Case presentation The clinical case will describe the events of healing a neuropathic diabetic foot ulcer beyond the standard of care treatment plan. It is one of the first case reports to describe vehicle ergonomics as an etiologic factor contributing to a diabetic foot ulcer. Once the patient becomes aware of the unnecessary source of pressure, education and care is provided to manage this likely source of daily pressure to the neuropathic foot. Conclusion The article emphasizes the importance of a complete assessment, including nontraditional factors, which may lead to diabetic complications.

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PEDIS Classification in Diabetic Foot Ulcers Patients

Journal of Indonesian Society for Vascular and Endovascular Surgery ◽

10.36864/jinasvs.2020.2.012 ◽

2020 ◽

Vol 1 (2) ◽

pp. 50-54

Author(s):

Radi Noorsyawal ◽

Fahmi Jaka Yusuf ◽

Kemas Dahlan ◽

Ratna Maila Dewi

Keyword(s):

Peripheral Arterial Disease ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

The United States ◽

Classification Systems ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Peripheral Arterial

Introduction: Diabetic foot ulcer are one of several serious complications of diabetes progression. Up to 15% of patients with diabetes have diabetic foot ulcer and these ulcers lead to more than 80,000 amputations per year in the United States. Many DFU classification systems have been proposed to predict clinical outcome; however, almost of these systems have limitations. To categorize and define DFU objectively, the International Working Group of the Diabetic Foot (IWGDF) developed the PEDIS classification system. These collective findings and because of there is no findings of characteristic of DFU based on PEDIS classification in Mohammad Hoesin Hospital indicate that this research is needed to do. Method: This is a prospective study at Mohammad Hoesin hospital, Palembang. The aim is to describe the characteristic of diabetic foot ulcers based on PEDIS classification. There were 41 cases evaluated under this study. Results: Peripheral arterial disease is the most problem in perfusion. 1-3 cm2 is the most happen in extent. Wound depth on fascia or muscle or tendon is the most happen. Abscess or fascitis is the most problem in infection. Loss of sensation is the most happen. PEDIS score ≥ 7 is the most happen. Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of diabetic foot ulcers patient. Keywords: Diabetic Foot Ulcer, PEDIS classification, Peripheral Arterial Disease

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Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10063 ◽

2018 ◽

Vol 12 (05) ◽

pp. 347-351 ◽

Cited By ~ 1

Author(s):

Michele Obeid ◽

Eric Moughames ◽

Petra Aboulhosn ◽

Rashad Madi ◽

Maya Farah ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Middle Eastern ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

The United States ◽

Pseudomonas Spp ◽

Diabetic Foot Infections ◽

Amoxicillin Clavulanate ◽

Susceptibility Profiles

Introduction: Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly Staphylococcus species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative Pseudomonas spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles. Methodology: We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon. Results: Among all isolates, Enterobacteriaceae (42%), Pseudomonas spp. (18.6%) and methicillin-sensitive Staphylococcus aureus (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of Pseudomonas spp. were susceptible to ciprofloxacin and 63.6% of Enterobacteriaceae were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant Staphylococcus aureus (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients. Conclusion: In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.

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Abstract #227 Occurrence of Common Pathogen Among Diabetic Foot Ulcer Patients in Saudi Arabia

Endocrine Practice ◽

10.1016/s1530-891x(20)47073-9 ◽

2018 ◽

Vol 24 ◽

pp. 42

Author(s):

Mohammed Aldawish ◽

Mousab Alayed

Keyword(s):

Saudi Arabia ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Common Pathogen

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STUDY OF SURGICAL MANAGEMENT AND COMPLICATIONS OF DIABETIC FOOT ULCER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i2.607 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Dr. Devi Das Verma ◽

Dr. Anil Kumar Saxena

Keyword(s):

Health Problem ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

World Health ◽

Foot Ulcers ◽

Age Group ◽

Major Health Problem ◽

Split Skin Grafting ◽

Foot Problems

Introduction: Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries. From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia. Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer. Material and method: Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included. From all the patients’ detailed past and present history were recorded. For all the patients, general, physical and local and systemic examinations were also done. Detail laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation. Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old. 6.7% showed the least age group as 20 -30 years old. Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot. Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers. Hence, foot infection is to put first and care for it like hands. Keywords: Diabetes, foot ulcers, infections, amputations.

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