Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético / Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot

Objetivo Corynebacterium striatum (C. striatum) es un microorganismo emergente en la infección de pie diabético poco estudiado. El objetivo es evaluar los factores de riesgo (FR) relacionados con osteomielitis por C. striatum en paciente con pie diabético. Métodos Estudio casos-controles en la Unidad de Pie Diabético entre 2015 y 2021. Un número de 44 pacientes con osteomielitis por C. striatum (casos) y 44 con osteomielitis por microorganismo distinto (controles) fueron incluidos. Resultados Enfermedad arterial periférica (odds ratio [OR]: 2,8, p = 0,037), fibrilación auricular (OR: 3,7, p = 0,034), pie diabético isquémico (OR: 3,3, p = 0,020) y antibioterapia previa prolongada más de 14 días (OR: 3,4, p = 0,012) fueron FR para la osteomielitis por C. striatum. En el análisis multivariado la antibioterapia más de 14 días fue el único FR independiente (OR: 3,46; p = 0,017) para osteomielitis por C. striatum. Conclusiones La antibioterapia previa recibida durante más de 14 días es un FR independiente y estadísticamente significativo de osteomielitis por C. striatum en pacientes con pie diabético (AU)

Objective Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. Methods A case–control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. Results Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). Conclusions Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot (AU)

[Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. / Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético.

OBJECTIVE: Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS: A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS: Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS: Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.

Validation of the Fast-Track Model: A Simple Tool to Assess the Severity of Diabetic Foot Ulcers.

This study aimed to validate the association between the grades of severity of diabetic foot ulcers (DFUs) identified by the fast-tack model and specific outcomes. Three hundred and sixty-seven patients with new DFUs who were referred to a tertiary level diabetic foot service serving Rome, Italy, were included. The fast-track model identifies three levels of DFUs' severity: uncomplicated DFUs, including superficial wounds, not-infected wounds, and not-ischemic wounds; complicated DFUs, including ischemic wounds, infected wounds, and deep ulcers involving the muscles, tendons, or bones, and any kind of ulcers in patients on dialysis and/or with heart failure; and severely complicated DFUs, including abscesses, wet gangrene, necrotizing fasciitis, fever, or clinical signs of sepsis. Healing, minor and major amputation, hospitalization, and survival after 24 weeks of follow-up were considered. Among the included patients, 35 (9.6%) had uncomplicated DFUs, 210 (57.2%) had complicated DFUs, and 122 (33.2%) had severely complicated DFUs. The outcomes for patients with uncomplicated, complicated, and severely complicated DFUs were as follows, respectively: healing, 97.1%, 86.2%, and 69.8%; minor amputation, 2.9%, 20%, and 66.4%; major amputation, 0%, 2.9%, and 16.4%; hospitalization, 14.3%, 55.7%, and 89.3%; survival, 100%, 96.7%, and 89.3%. DFU severity was an independent predictor of healing, amputation, hospitalization, and survival. The current study shows an association between the grade of severity of DFUs identified by the fast-track model and the considered outcomes. The fast-track model may be a useful tool for assessing the severity and prognosis of DFUs.

Effectiveness of fast-track pathway for diabetic foot ulcerations.

AIM: To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS: The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS: Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION: After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.

Referral of patients with diabetic foot ulcers in four European countries: patient follow-up after first GP visit.

OBJECTIVE: This study aimed to analyse the characteristics of patients, including demographics, medical history and treatment, with a diabetic foot ulcer (DFU) during their first follow-up visit to a general practitioner (GP). METHODS: A two-part quantitative online questionnaire was distributed among GPs in France, UK, Germany and Spain. Part one entailed a survey of GPs' perceptions of referrals for DFU. Part two collected data on recently managed DFU cases. The percentage of responses was compared for each question and across the four countries for significant differences. RESULTS: In part one of the study, 600 questionnaires were collected (150 per country) and 1188 patients managed for a DFU were included in the second part. About 88% of patients had type 2 diabetes, with a significant proportion of suboptimal control (average HbA1c: 10.64mmol/l). A patient complaint led to diagnosis in 60% of the cases. Wounds were found to be more frequently located in the toes and midfoot, and were superficial (according to the Texas Wound Classification system) in 80% of the cases. More than two-thirds of patients developed small wounds (<5cm2); more than half of them had infected wounds. Approximately 50% of wounds were ischaemic, which triggered the onset of a DFU. Follow-up wound examinations before and after hospitalisation were performed by nurses, except in Germany where GPs undertook this role, including prescribing offloading devices and in the UK where follow-up was managed by podiatrists. Ischaemia, wound necrosis, suspected osteomyelitis and absence of wound healing were the primary reasons for hospital admission during the first month after diagnosis. CONCLUSION: Delay in specialised foot care is a recurring topic in the treatment of DFUs, even with different health-care structures across Europe. Knowledge and education on DFUs should be reinforced among GPs and nurses to establish a global DFU care network between primary and specialised care, avoid hospitalisation and adequately manage high-risk patients.

Perception of diabetic foot ulcers among general practitioners in four European countries: knowledge, skills and urgency.

OBJECTIVE: Diabetic foot ulcers (DFU) have the potential to deteriorate rapidly, in the absence of prompt assessment and treatment. The aim of this study was to analyse the awareness and perception of DFU among general practitioners (GPs) from four European countries, and to find possible differences between these countries in terms of management. METHOD: A two-part, quantitative, online questionnaire was distributed to GPs across four countries in Europe-the UK, France, Germany and Spain. The first part entailed a survey on the perception and knowledge of the pathogenesis and management of DFU, among GPs. The second part of the questionnaire was used for the collection of data on recently-managed DFU cases. RESULTS: For the first part of the study, 600 questionnaires were collected (150 per country) and 1188 patient cases of DFU management were included in the second part. In France, only 49% of GPs mentioned neuropathy as the main causative process in DFU development. However, in Germany and the UK, 82% and 83% of GPs, respectively, considered neuropathy as an important causative factor. DFU care in Spain and the UK is thought to be organised by multidisciplinary teams (MDT) (83% and 84% of GPs, respectively, completely agreed with this statement). In France and Germany, GPs are responsible for follow-up and management. Only UK physicians have clearly identified specialised podiatrists to refer patients to, if needed. Approximately 29-40% of GPs in all countries did not feel they were sufficiently trained in the DFU treatment protocol. Almost 30% of GPs in France and Germany thought that DFU treatment was not well-established due to the absence of clinical guidelines and protocols. CONCLUSION: The intra-country and inter-country management of the complex aspects of DFU is quite heterogeneous. The cause of this finding is multifactorial. Although there are international guidelines, it would be beneficial to establish clear and specific competencies for the different health professionals involved in DFU management. As a minimum, intra-country heterogeneity should improve with their development.

Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units.

OBJECTIVE: Diabetic foot ulceration (DFU) has the potential to deteriorate rapidly without prompt assessment and treatment. The aim of this study was to assess the referral patterns for DFU, from primary care to specialised diabetes foot care units. METHOD: A two-part, quantitative, online questionnaire was administered to GPs across four countries in Europe: France, the UK, Germany and Spain. The first part entailed a survey of GPs' perceptions of referrals for DFU. The second part of the questionnaire collected data on recently managed DFU cases. RESULTS: There were 600 questionnaires collected in the first part of the study (150 per country), and 1188 patient cases of DFU management were included in the second part. Up to 95% of patients had type 2 diabetes. Patients' complaints led to diagnosis, on average, 60% of the time, and the diagnosis was an incidental finding during a consultation 13-28% of the time. On average, only 40% of GPs completely agreed that they have clearly identified DFU clinical practitioners working in a hospital facility. In 55-66% of cases, the duration of DFU was unknown or DFU diagnosis was delayed more than three weeks from the onset of the wound. On average, 48% of patients were referred after an unknown duration or more than one month from the onset of DFU. CONCLUSION: Despite differences in health-care structures across Europe, delays in referral to specialist foot care teams seems to be a common theme. There is an ongoing need to educate GPs, nurses and patients to be more aware of the risk of DFU, and the need for prompt referral to specialist diabetic foot teams.

Melanoma: criterios diagnósticos en podología

La aparición cada vez más común de neoformaciones cutáneas evolutivas, con desarrollo veloz y crecimiento invasivo (como es el melanoma), proporciona al profesional sanitario y en consecuencia al podólogo la necesidad de permanecer en continua alerta ante cualquier lesión dérmica sospechosa. La necesidad por parte del podólogo de utilizar la inspección como herramienta fundamental dentro de la historia clínica del paciente, hace más frecuente el descubrimiento, muchas veces accidental, de neoformaciones cutáneas malignas. Este artículo pretende concienciar al podólogo con respecto a que, ante cualquier lesión cutánea evolutiva sospechosa, es necesario solicitar pruebas complementarias como por ejemplo la técnica del ganglio centinela, con el fin de obtener un informe oncológico y/o anatomopatológico fundamental antes de tomar cualquier decisión terapéutica (AU)