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Clinical Research
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Risk factors for osteomyelitis associated with diabetic foot wounds First Author: Lawrence Lavery Authors: Lawrence A. Lavery, Edgar J.G. Peters, David G. Armstrong, Christopher S. Wendel, Douglas P. Murdoch, Benjamin A. Lipsky Purpose: To assess risk factors for developing osteomyelitis of the foot in persons with diabetes. Methods: We enrolled 1666 consecutive persons with diabetes who presented to a large, urban, managed-care diabetes disease management program. The patients underwent a standardized general medical and detailed foot assessment at enrollment and high risk patients had regular foot examinations thereafter. Foot infections (soft tissue and bone) were defined by criteria consistent with International Working Group guidelines. Osteomyelitis was defined as a positive bone culture. Results: Of the first 1666 persons enrolled, 50.3% were male and the mean age was 69.1?11.1 years. Over a mean of 27.2 months of follow-up 151 people developing 199 foot infections., 19.9% of which involved bone. Independent risk factors associated with developing osteomyelitis included: wounds that extended to bone or joint (Relative Risk 23.1), previous history of a wound prior to enrollment (Relative Risk=2.2), and recurrent/ multiple wounds during the study period (Relative Risk=1.9). Conclusions: Foot infection is a frequent complication of foot ulcers. This study identified several independent risk factors for developing bone infection; recognizing these may help target efforts to reduce risk for lower extremity amputation. |
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