Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Avoiding amputation: Early infection intervention can save feet & legs

16.06.2005


Diabetes patients may benefit most from minor surgery plus antibiotics



A small sore on a toe may not seem like a major medical threat. But for the millions of people who have diabetes and other conditions, it can be the first step on a road that leads to the amputation of a foot -- or even a leg. Now, a new study from the University of Michigan Cardiovascular Center may help more people save their limbs. Published in the June issue of the Annals of Surgery, it’s the first-ever large study of how foot-bone infection, called osteomyelitis, is typically treated and how well the different approaches work.

Because diabetes interferes with the body’s ability to heal, even the smallest foot wounds can become infected, spread to the bone, and lead to an amputation. Poor circulation and numb feet, also common in people with diabetes, make the situation worse. More than 80,000 such amputations happen each year in the United States. Experts already recommend that people with diabetes take special care of their feet and have regular foot exams to spot problems early.


The study is the first large account of the prevalence, treatment characteristics and high cost of treating osteomyelitis, which interferes with walking and sends thousands of people to the hospital each year.

On average, it shows, patients stayed in the hospital for about a week at an average cost of $19,000. Almost one in every thousand hospitalizations may be due to foot osteomyelitis, the study suggests.

"This study grew out of our own observations that many osteomyelitis patients were being treated for months or even years with antibiotics, but not healing, and this can contribute to the loss of their foot or leg," says lead author Peter Henke, M.D., an assistant professor of vascular surgery at the U-M Medical School. "But there’s little evidence to guide treatment, so we wanted to look at epidemiology and outcomes. Our results show this is a common, costly issue that needs much further study."

Henke and his colleagues performed the study using data from the Nationwide Inpatient Sample, a database of hospital patient information maintained by the federal Agency on Health Care Research and Quality. They also used data from 237 osteomyelitis patients treated at the University of Michigan. Both sets of data were from patients treated between 1993 and 2000.

In all, the national data showed that 8.5 percent of patients hospitalized for foot osteomyelitis had a leg or foot amputated, and 23 percent had a toe amputated. About 1.6 percent died before leaving the hospital. Patients who were older, African American or had kidney problems were more likely to have an amputation.

Of the U-M osteomyelitis patients, 80 percent had diabetes, and 30 percent had chronic kidney problems. Nearly 40 percent also had blockage in the blood vessels of their legs, a condition called peripheral vascular occlusive disease. Nearly a quarter of the patients died within 31 months of their hospital stay. "This is a patient population in which a non-healing foot wound becomes an ulcer, exposes the bone, and leads to osteomyelitis," says Henke.

About half of the U-M patients had been on antibiotics before being hospitalized, many of them on intravenous doses of the drugs. On average, patients had been on antibiotics for five months, and 30 percent had had more than one course of antibiotics prescribed to them before being admitted.

However, U-M patients who had been on antibiotics before they entered the hospital were much less likely to heal -- perhaps because the bacteria in their infected wound had grown resistant to antibiotics. Those who had been on antibiotics for a long time before hospitalization were also less likely to keep their limbs, possibly because the non-healing infection spread too far to allow the foot or leg to be saved. The national data did not include pre-hospital antibiotic use.

But the patients who had blood vessel reconstruction to improve circulation in their legs and feet were several times more likely to have successful wound healing and to keep their foot or leg. Toe amputees were also more likely to keep their limbs.

Patients who had clogged leg blood vessels -- the condition known as peripheral vascular occlusive disease or PVOD -- before their hospitalization were far less likely to keep their legs or feet over time. The patients in the study, Henke notes, were younger and more likely to have diabetes than the typical PVOD patient, but had a higher than usual risk of losing a foot or leg.

"This study suggests that antibiotics alone are not as effective as surgery plus antibiotics, both for healing wounds and saving limbs," says Henke. "It also suggests that diabetic patients, especially those with PVOD, have a very high chance of developing osteomyelitis -- and that these patients should be considered for aggressive arterial reconstruction or other early intervention. This also really drives home the need for good foot care for all patients with diabetes."

Among the steps recommended for all people with diabetes are to examine their feet daily for any signs of redness, blisters, cuts or sores; to wear well-fitting shoes and protect their feet from injury; and to remove their shoes and socks at each diabetes-related checkup so feet can be examined

The researchers also find that patients whose wounds didn’t heal, and those who didn’t receive early surgical intervention, were much more likely to use home-health services after leaving the hospital. This kind of care, and outpatient visits, must also be considered when the costs of osteomyelitis are tallied, says Henke. But since surgery can decrease the need for outpatient visits, it may also help reduce costs of caring for a non-hospitalized osteomyelitis patient.

Because the U-M study was performed using retrospective data, the authors say a large prospective study comparing antibiotic use with surgical therapy will be needed to confirm their results before they have an impact on clinical care.

Kara Gavin | EurekAlert!
Further information:
http://www.umich.edu

More articles from Health and Medicine:

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

nachricht The first analysis of Ewing's sarcoma methyloma opens doors to new treatments
01.12.2016 | IDIBELL-Bellvitge Biomedical Research Institute

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

Im Focus: Molecules change shape when wet

Broadband rotational spectroscopy unravels structural reshaping of isolated molecules in the gas phase to accommodate water

In two recent publications in the Journal of Chemical Physics and in the Journal of Physical Chemistry Letters, researchers around Melanie Schnell from the Max...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

IHP presents the fastest silicon-based transistor in the world

05.12.2016 | Power and Electrical Engineering

InLight study: insights into chemical processes using light

05.12.2016 | Materials Sciences

High-precision magnetic field sensing

05.12.2016 | Power and Electrical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>