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1.  Severity of Diabetic Foot Infection and Rate of Limb Salvage 
Background
Foot infections are limb threatening complications in patients with diabetes mellitus (DM) and proper classification of diabetic foot infection (DFI) severity is important in establishing the proper antibiotic regimen, the need for hospitalization and surgery and the risk of amputation. Our hypothesis was that patients with severe DFI would have a longer hospitalization than those with moderate DFI. The purposed of this study was two fold. The first purpose was to define DFI using readily available clinical information and objective parameters outlined by consensus statements. The second purpose of this study was the assess the amputation and limb salvage rates for hospitalized patients with DFI.
Materials and methods
The database of a single academic foot and ankle program was reviewed for patients who were hospitalized for a DFI from 2006-2011. Inpatient and outpatient electronic medical records identified 100 patients. Severe DFI was defined as having two or more objective findings of systemic toxicity and/or metabolic instability at the time of initial assessment.
Results
The length of stay was significantly shorter for patients with a moderate infection than those with a severe infection (median 5 days versus 8 days, p=0.021). A non-significant trend indicating higher rates of limb salvage in patients with moderate infections compared to patients with severe infections was observed (94% versus 80%, p=0.081).
Summary and Conclusion
As hypothesized, patients with severe DFI had a median hospital stay that was 60% longer than patients with moderate DFI. In this sample, 55% of patients with a severe DFI required some type of amputation compared to 42 % of patients with a moderate DFI.
doi:10.1177/1071100712467980
PMCID: PMC4016951  PMID: 23520292
diabetic foot infection definition severe
2.  Diabetic foot infections: current concept review 
Diabetic Foot & Ankle  2012;3:10.3402/dfa.v3i0.18409.
The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high morbidity and risk factors for failure of treatment and classification systems are also described. Most diabetic foot infections begin with a wound and once an infection occurs, the risk of hospitalization and amputation increases dramatically. Early identification of infection and prompt treatment may optimize the patient's outcome and provide limb salvage.
doi:10.3402/dfa.v3i0.18409
PMCID: PMC3349147  PMID: 22577496
diabetic foot infection; ulcer; guidelines; surgery
3.  Surgical Site Infections After Foot and Ankle Surgery 
Diabetes Care  2011;34(10):2211-2213.
OBJECTIVE
This prospective study was designed to evaluate the rate of surgical site infection (SSI) after foot and ankle surgery in patients with and without diabetes.
RESEARCH DESIGN AND METHODS
The study prospectively evaluated 1,465 consecutive foot and ankle surgical cases performed by a single surgeon.
RESULTS
The overall SSI rate in this study was 3.5%, with significantly more infections occurring in individuals with diabetes than in those without (9.5 vs. 2.4%, P < 0.001). Peripheral neuropathy, Charcot neuroarthropathy, current or past smoking, and increasing length of surgery were significantly associated with SSI on multivariate analysis.
CONCLUSIONS
This study demonstrates significant associations between the development of SSI and chronic complications of diabetes. We confirm previous findings that it is peripheral neuropathy and not diabetes itself that most strongly determines the development of postoperative infections in these surgical patients.
doi:10.2337/dc11-0846
PMCID: PMC3177737  PMID: 21816974
4.  The Charcot Foot in Diabetes 
Diabetes Care  2011;34(9):2123-2129.
The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.
doi:10.2337/dc11-0844
PMCID: PMC3161273  PMID: 21868781

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