Robert J Commons1, Claire H Robinson2, David Gawler3, Joshua S Davis4, Ric N Price5. 1. Department of Infectious Diseases, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia. Electronic address: robert.commons@gmail.com. 2. High Risk Foot Service, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia. 3. Division of Surgery, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia. 4. Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia. 5. Department of Infectious Diseases, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, UK.
Abstract
INTRODUCTION: The risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital. METHODS: All adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. RESULTS: There were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR)=5.1, [95%CI=3.8, 7.0]), were younger (mean difference of 11.1 years; p<0.001), and more likely to undergo major and minor amputations (RR=4.1 [95%CI=1.6, 10.7], and 6.2 [95%CI=3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. aureus was present in 44.7% of wounds from Indigenous patients versus 20.6% of non-Indigenous patients (Odds Ratio (OR)=3.1, [95%CI=1.5, 6.4]), whereas P. aeruginosa presence was significantly lower (15.8% versus 46.0%; OR=0.22; [95%CI=0.11, 0.45]). Methicillin resistant S. aureus or P. aeruginosa infections were associated with longer antibiotic courses and durations of stay. CONCLUSIONS: This study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population.
INTRODUCTION: The risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital. METHODS: All adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. RESULTS: There were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR)=5.1, [95%CI=3.8, 7.0]), were younger (mean difference of 11.1 years; p<0.001), and more likely to undergo major and minor amputations (RR=4.1 [95%CI=1.6, 10.7], and 6.2 [95%CI=3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. aureus was present in 44.7% of wounds from Indigenous patients versus 20.6% of non-Indigenous patients (Odds Ratio (OR)=3.1, [95%CI=1.5, 6.4]), whereas P. aeruginosa presence was significantly lower (15.8% versus 46.0%; OR=0.22; [95%CI=0.11, 0.45]). Methicillin resistant S. aureus or P. aeruginosa infections were associated with longer antibiotic courses and durations of stay. CONCLUSIONS: This study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population.
Authors: B A Lipsky; E J G Peters; E Senneville; A R Berendt; J M Embil; L A Lavery; V Urbančič-Rovan; W J Jeffcoate Journal: Diabetes Metab Res Rev Date: 2012-02 Impact factor: 4.876
Authors: David W Dunstan; Paul Z Zimmet; Timothy A Welborn; Maximilian P De Courten; Adrian J Cameron; Richard A Sicree; Terry Dwyer; Stephen Colagiuri; Damien Jolley; Matthew Knuiman; Robert Atkins; Jonathan E Shaw Journal: Diabetes Care Date: 2002-05 Impact factor: 19.112
Authors: Christopher Yates; Kerry May; Thomas Hale; Bernard Allard; Naomi Rowlings; Amy Freeman; Jessica Harrison; Jane McCann; Paul Wraight Journal: Diabetes Care Date: 2009-07-08 Impact factor: 19.112
Authors: Robert J Commons; James Charles; Jane Cheney; Sarah A Lynar; Matthew Malone; Edward Raby Journal: J Foot Ankle Res Date: 2022-06-09 Impact factor: 3.050
Authors: Limin Jia; Christina N Parker; Tony J Parker; Ewan M Kinnear; Patrick H Derhy; Ann M Alvarado; Flavia Huygens; Peter A Lazzarini Journal: PLoS One Date: 2017-05-17 Impact factor: 3.240
Authors: Robert J Commons; Edward Raby; Eugene Athan; Hasan Bhally; Sharon Chen; Stephen Guy; Paul R Ingram; Katy Lai; Chris Lemoh; Lyn-Li Lim; Laurens Manning; Spiros Miyakis; Mary O'Reilly; Adam Roberts; Marjoree Sehu; Adrienne Torda; Mauro Vicaretti; Peter A Lazzarini Journal: J Foot Ankle Res Date: 2018-04-10 Impact factor: 2.303
Authors: Legesse Garedew Kifelew; Morgyn S Warner; Sandra Morales; Lewis Vaughan; Richard Woodman; Robert Fitridge; James G Mitchell; Peter Speck Journal: BMC Microbiol Date: 2020-07-09 Impact factor: 3.605