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ANALYSIS OF RISK FACTORS FOR
DIABETIC FOOT INFECTIONS
LEADING TO HOSPITAL ADMISSION ,
SEEN IN A TERTIARY DIABETIC
CENTRE.
AIM:1)To analyze the risk factors associated with, and leading to
hospital admission for diabetic foot infection.
2)To dev...
PROFILE OF PATIENTS:
N 72
Mean Age 57.5(±8.9)yrs
Male:Female 75:25
Type of D.M Type 2
Duration of Diabetes 27.1% <5yrs
12....
others
obvious injury
foot-wear
induced
thermal injury
not known
ETIOLOGY
40.3%33.3%
18.3%
8.5%
MODE OF INJURY:
Not Known ...
Duration of infection
before hospital admission
46.5% 1wk-1Mth
34.7% >1Mth
19.4% <1Wk
Medical attention sought
before comi...
CHARACTERISTIC OF THE WOUNDS
SITE 50% Toes
16% Foot-Mid Foot Planter
11% Heel
SIZE 70.8% 2-5cm
SIDE 45.8% Left
44.4% Right...
0
5
10
15
20
25
30
1A 1C 2A 2C 3A 3C
% Of pt
TEXAS’ CLASSIFICATION
Texas’ Classification
%ofpatients
INTERVENTION
CONSERVATIVE 13.9%
DEBRIDEMENT 48.6%
MINOR
AMPUTATION
9.7%
MAJOR
AMPUTATION
8.3%
DEBD + Mn AMP 15.0%
Conserva...
RESULTS
AGE Vs PREVALENCE OF FOOT INFECTION
2.8
22
34.7
40.2
0
5
10
15
20
25
30
35
40
45
< 40 41 - 50 51 - 60 > 61
Age (years) →
P...
BLOOD GLUCOSE AT BASELINE & AFTER INTERVENTION
0A
0
50
100
150
200
250
300
350
BASELINE DISCHARGE
RBS
FBS
PPBS
298± 100
20...
DURATION OF DIABETES Vs INTERVENTION
0
10
20
30
40
50
60
Conservative Surgery
< 5 years 6 - 9 years
> 15 years10 - 15 year...
HbA1c Vs INTERVENTION
0
5
10
15
20
25
30
<7.0 7.0-9.0 >9.0
con
dbd
toe amp
fore foot
midfoot
AK
BK
Hip
Dbd+Toe
Dbd+midfoot...
DURATION OF INFECTION Vs INTERVENTION
0
2
4
6
8
10
12
14
16
<1 WK >1WK
AMP TOE
B K AMP
DURATION OF ILLNESS VS INTERVENTION...
PREVIOUS TREATMENT Vs INTERVENTION
0
2
4
6
8
10
12
14
16
18
CON FOREFOOT
AMP
FMLY PHY
HOSP
12.5
16 16.7
8.0
PREVIOUS TREAT...
CONCLUSION
1)Elderly , long duration of diabetes.high HbA1c levels & patient with diabetic
neuropathy are at particular risk for foot...
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1362574218 dr.mriganka

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1362574218 dr.mriganka

  1. 1. ANALYSIS OF RISK FACTORS FOR DIABETIC FOOT INFECTIONS LEADING TO HOSPITAL ADMISSION , SEEN IN A TERTIARY DIABETIC CENTRE.
  2. 2. AIM:1)To analyze the risk factors associated with, and leading to hospital admission for diabetic foot infection. 2)To develop strategies to reduce the incidence of surgeries and amputations. METHODS:Consecutive patients admitted for foot-infection in D.R.C(n=72) during the period from May 06 to July 06 were included in the study.History in the form of questionnaires, including mode of injury, previous treatment taken before admission (if yes,from whom,after how many days of injury) were analyzed.Biochemical parameters at baseline and at discharge were tabulated.Wound morphology was compared according to Texas’ Classification.Outcome ,in comparison to various parameters were analyzed.
  3. 3. PROFILE OF PATIENTS: N 72 Mean Age 57.5(±8.9)yrs Male:Female 75:25 Type of D.M Type 2 Duration of Diabetes 27.1% <5yrs 12.9% 5-10yrs 60.0% >10yrs Regularity of diabetic medications 72.2% Regular 27.8% Irregular R.B.S(Mean) 298 (±100)Mg% HbA1c 10.4%(±2.6%) Neuropathy 98.6% P.VD 22.2%
  4. 4. others obvious injury foot-wear induced thermal injury not known ETIOLOGY 40.3%33.3% 18.3% 8.5% MODE OF INJURY: Not Known 40.3% Obvious Injury 33.3% Foot wear induced 18.3% Thermal Injury 8.5%
  5. 5. Duration of infection before hospital admission 46.5% 1wk-1Mth 34.7% >1Mth 19.4% <1Wk Medical attention sought before coming to D.R.C 73.2% Yes 26.8% No Onset of treatment after injury 16.7% <24Hrs 76.3% >24Hrs Treatment was given by: 47.1%(25) Family Physician 52.9%(28) Local Hospital History of previous foot infection 44.4% Yes HISTORY OF PRESENTING FOOT-INFECTION
  6. 6. CHARACTERISTIC OF THE WOUNDS SITE 50% Toes 16% Foot-Mid Foot Planter 11% Heel SIZE 70.8% 2-5cm SIDE 45.8% Left 44.4% Right 9.7% Bilateral DEPTH 50.0% Probing to tendon/capsule 40.3% Probing to bone 9.7% Superficial ORGANISM ISOLATED 20.4% E-Coli 18% Enterococci 15.2% Cuagulase Negative Staphylococci 7.9% Klebsiella 5.6% M.R.S.A
  7. 7. 0 5 10 15 20 25 30 1A 1C 2A 2C 3A 3C % Of pt TEXAS’ CLASSIFICATION Texas’ Classification %ofpatients
  8. 8. INTERVENTION CONSERVATIVE 13.9% DEBRIDEMENT 48.6% MINOR AMPUTATION 9.7% MAJOR AMPUTATION 8.3% DEBD + Mn AMP 15.0% Conservativ e Dbd Mn amp Mj Amp Dbd+Mn amo 48.6% 13.9%15% 8.3% 9.7% INTERVENTION
  9. 9. RESULTS
  10. 10. AGE Vs PREVALENCE OF FOOT INFECTION 2.8 22 34.7 40.2 0 5 10 15 20 25 30 35 40 45 < 40 41 - 50 51 - 60 > 61 Age (years) → Prevalenceoffootinfection
  11. 11. BLOOD GLUCOSE AT BASELINE & AFTER INTERVENTION 0A 0 50 100 150 200 250 300 350 BASELINE DISCHARGE RBS FBS PPBS 298± 100 203± 92 242± 96 204± 53 126± 36 176± 360 Time BloodGlucose
  12. 12. DURATION OF DIABETES Vs INTERVENTION 0 10 20 30 40 50 60 Conservative Surgery < 5 years 6 - 9 years > 15 years10 - 15 years Percentageofpatients Level of Intervention
  13. 13. HbA1c Vs INTERVENTION 0 5 10 15 20 25 30 <7.0 7.0-9.0 >9.0 con dbd toe amp fore foot midfoot AK BK Hip Dbd+Toe Dbd+midfoot (10.0%) (21.4%) (68.6%) PercentageofPatients HbA1c Level
  14. 14. DURATION OF INFECTION Vs INTERVENTION 0 2 4 6 8 10 12 14 16 <1 WK >1WK AMP TOE B K AMP DURATION OF ILLNESS VS INTERVENTION 7.1% 15.1% 12.1% PercentageofPatients Duration of Infection
  15. 15. PREVIOUS TREATMENT Vs INTERVENTION 0 2 4 6 8 10 12 14 16 18 CON FOREFOOT AMP FMLY PHY HOSP 12.5 16 16.7 8.0 PREVIOUS TREATMENT vs INTERVENTION PercentageofPatients Level of Intervention
  16. 16. CONCLUSION
  17. 17. 1)Elderly , long duration of diabetes.high HbA1c levels & patient with diabetic neuropathy are at particular risk for foot injury and infection. 2)Family physician seems to play an important role in the initial management, who needs to be made more aware of impending adverse outcome of foot injury in a diabetic patient. 3)E-Coli is the most frequently isolated organism. 4)Outcome of patient is influenced by Duration of diabetes  Duration of foot-infection HbA1c levels Previous treatment sought 5)Proper intervention leads to reduction of blood sugars at all time of the day. 6)Aggressive education & awareness about foot care, appropriate foot-wear & importance of seeking of timely medical advise in case of foot injury can reduce the level of intervention in all group of diabetic patients.

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