Meryl Cinzía Tila Tamara Gramberg1,2,3,4, Shaya Krishnaa Normadevi Mahadew5, Birgit Ilja Lissenberg-Witte6, Marielle Petra Bleijenberg5, Jara Rebekka de la Court5,7, Jarne Marijn van Hattem8, Louise Willy Elizabeth Sabelis9,10,11, Rimke Sabine Lagrand9,10,11, Vincent de Groot9,10,11, Martin Den Heijer12, Edgar Josephus Gerardus Peters5,9,7,11. 1. Amsterdam UMC Location Vrije Universiteit Amsterdam, Infectious Diseases, De Boelelaan 1117, Amsterdam, The Netherlands. m.gramberg@amsterdamumc.nl. 2. Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands. m.gramberg@amsterdamumc.nl. 3. Amsterdam Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands. m.gramberg@amsterdamumc.nl. 4. Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands. m.gramberg@amsterdamumc.nl. 5. Amsterdam UMC Location Vrije Universiteit Amsterdam, Infectious Diseases, De Boelelaan 1117, Amsterdam, The Netherlands. 6. Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands. 7. Amsterdam Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands. 8. Amsterdam UMC Location University of Amsterdam Medical Microbiology and Infection Prevention, Meibergdreef 9, Amsterdam, The Netherlands. 9. Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands. 10. Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands. 11. Amsterdam UMC Center for Diabetic Foot Complications (ACDC), Amsterdam, The Netherlands. 12. Amsterdam UMC Location Vrije Universiteit Amsterdam, Endocrinology, De Boelelaan 1117, Amsterdam, The Netherlands.
Abstract
PURPOSE: Different bacteria lead to divers diabetic foot infections (DFIs), and some bacteria probably lead to higher amputation and mortality risks. We assessed mortality and amputation risk in relation to bacterial profiles in people DFI and investigated the role of sampling method. METHODS: We included people (> 18 years) with DFI in this retrospective study (2011-2020) at a Dutch tertiary care hospital. We retrieved cultures according to best sampling method: (1) bone biopsy; (2) ulcer bed biopsy; and (3) swab. We aggregated data into a composite determinant, consisting of unrepeated bacteria of one episode of infection, clustered into 5 profiles: (1) Streptococcus and Staphylococcus aureus; (2) coagulase-negative Staphylococcus, Cutibacterium, Corynebacterium and Enterococcus; (3) gram-negative; (4) Anaerobic; and (5) less common gram-positive bacteria. We calculated Hazard Ratio's (HR's) using time-dependent-Cox regression for the analyses and investigated effect modification by sampling method. RESULTS: We included 139 people, with 447 person-years follow-up and 459 episodes of infection. Sampling method modified the association between bacterial profiles and amputation for profile 2. HR's (95% CI's) for amputation for bacterial profiles 1-5: 0.7 (0.39-1.1); stratified analysis for profile 2: bone biopsy 0.84 (0.26-2.7), ulcer bed biopsy 0.89 (0.34-2.3), swab 5.9*(2.9-11.8); 1.3 (0.78-2.1); 1.6 (0.91-2.6); 1.6 (0.58-4.5). HR's (95% CI's) for mortality for bacterial profiles 1-5: 0.89 (0.49-1.6); 0.73 (0.38-1.4); 2.6*(1.4-4.8); 1.1(0.58-2.2); 0.80(0.19-3.3). CONCLUSIONS: In people with DFI, there was no association between bacterial profiles in ulcer bed and bone biopsies and amputation. Only in swab cultures, low-pathogenic bacteria (profile 2), were associated with a higher amputation risk. Infection with gram-negative bacteria was associated with a higher mortality risk. This study underlined the possible negative outcome of DFI treatment based on swabs cultures.
PURPOSE: Different bacteria lead to divers diabetic foot infections (DFIs), and some bacteria probably lead to higher amputation and mortality risks. We assessed mortality and amputation risk in relation to bacterial profiles in people DFI and investigated the role of sampling method. METHODS: We included people (> 18 years) with DFI in this retrospective study (2011-2020) at a Dutch tertiary care hospital. We retrieved cultures according to best sampling method: (1) bone biopsy; (2) ulcer bed biopsy; and (3) swab. We aggregated data into a composite determinant, consisting of unrepeated bacteria of one episode of infection, clustered into 5 profiles: (1) Streptococcus and Staphylococcus aureus; (2) coagulase-negative Staphylococcus, Cutibacterium, Corynebacterium and Enterococcus; (3) gram-negative; (4) Anaerobic; and (5) less common gram-positive bacteria. We calculated Hazard Ratio's (HR's) using time-dependent-Cox regression for the analyses and investigated effect modification by sampling method. RESULTS: We included 139 people, with 447 person-years follow-up and 459 episodes of infection. Sampling method modified the association between bacterial profiles and amputation for profile 2. HR's (95% CI's) for amputation for bacterial profiles 1-5: 0.7 (0.39-1.1); stratified analysis for profile 2: bone biopsy 0.84 (0.26-2.7), ulcer bed biopsy 0.89 (0.34-2.3), swab 5.9*(2.9-11.8); 1.3 (0.78-2.1); 1.6 (0.91-2.6); 1.6 (0.58-4.5). HR's (95% CI's) for mortality for bacterial profiles 1-5: 0.89 (0.49-1.6); 0.73 (0.38-1.4); 2.6*(1.4-4.8); 1.1(0.58-2.2); 0.80(0.19-3.3). CONCLUSIONS: In people with DFI, there was no association between bacterial profiles in ulcer bed and bone biopsies and amputation. Only in swab cultures, low-pathogenic bacteria (profile 2), were associated with a higher amputation risk. Infection with gram-negative bacteria was associated with a higher mortality risk. This study underlined the possible negative outcome of DFI treatment based on swabs cultures.
Authors: Heather Young; Whitney Miller; Randy Burnham; Susan Heard; Chrystal Berg; Timothy C Jenkins Journal: Open Forum Infect Dis Date: 2017-02-11 Impact factor: 3.835