Predicting Amputation in Patients With Diabetic Foot Ulcers: A Systematic Review.

Foot ulcers are a leading cause of morbidity in diabetics. One of the known complications of diabetic foot ulcers is lower limb amputation which makes it a major socioeconomic problem. Currently, there's a lack of knowledge on the predictors of amputations in diabetics with foot ulcers. We performed a systematic review of studies that identified risk factors of amputation in patients with diabetic foot ulcers. This systematic review aims to identify the predictors of amputation in order to optimize the management strategy and care plan. Medline database was searched and inclusion criteria were implemented for the selection of studies. The risk factors extracted were part of four categories: (i) history and physical examination, (ii) ulcer characteristics, (iii) lab results, and (iv) co-morbidities. The data extracted were in the form of odds ratios, 95% confidence intervals, and predictive values. The mean values with standard deviations of the included risk factors were recorded, and the incidence of risk factors among the amputation groups was identified or calculated when the data were sufficient. Seven articles were selected reporting on 3481 patients. This review identified peripheral arterial disease, neuropathy, high Wagner's grade, osteomyelitis, postprandial glucose level, white cell count, c-reactive protein, erythrocyte sedimentation rate, low hemoglobin, and albumin as the most significant predictors of amputation.

A Case of Successfully Treated Central Line-Associated Bloodstream Infection Due to Vancomycin-Resistant Leuconostoc Citreum in a Child With Biliary Atresia.

Infections caused by the Leuconostocspecies have been increasingly described in the literature. They are Gram-positive, catalase-negative cocci that are intrinsically resistant to glycopeptides, including vancomycin. Although rarely pathogenic in humans, they have been primarily found in patients with immunosuppression, and a history of prolonged antibiotics use. We report a rare case of central venous catheter (CVC) infection caused by Leuconostoc citreum, which was successfully treated with salvaging of the CVC, aiming to highlight the potential risk factors and share the course of management of our patient.

A Rare Case of Pediatric Central Venous Catheter-Related Bloodstream Infection With Kocuria Varians.

Cases of central line blood infections caused by Kocuria spp. are limited in the literature. Most of those infections have been detected in hospitalized patients with severe underlying disease or those with implanted catheters or with suppressed immunity. They are usually non-pathogenic in humans, but few cases of opportunistic infections in adult and pediatric populations have been reported. They can be serious in certain occasions. So treating physicians should not underestimate or ignore the significance of the infection with these bacteria. We report a rare case of central venous catheter (CVC) infection associated with Kocuria varians, which was successfully treated with CVC salvage.