Dept. of Internal Medicine - Corazon Locsin Montelibano Memorial Regional Hospital
OBJECTIVES: Diabetic foot infections (DM Foot) are prevalent worldwide, causing burden to patients due to its high risk of morbidity, high recurrence rate and increased risk of amputation. It is considered the most common cause of hospitalization among diabetic patients. The DM Foot Protocol was revised to give more focus on the interdepartmental management this problem. This study aims to compare the outcome of patients with DM foot infections in CLMMRH before and after the revision of the DM Foot Protocol in terms of amputation rate, mortality rate and length of hospital stay.
METHODOLOGY: This is a retrospective review of 644 patient charts admitted from March 2014 to February 2016 diagnosed with diabetic foot based on Wagner Classification. All patients 19 years old and above, admitted and diagnosed with diabetic foot infection were included in the study. Data was collected from patient charts retrieved from the medical records section using the International Code for Diseases. Data collected included age, sex, baseline WBC upon admission, mean capillary blood glucose levels, creatinine clearance, glycosylated hemoglobin, Wagner classification and current medications. Length of hospital stay, co-morbidities, antibiotic history, and culture results of wound specimen were also recorded.
RESULTS: The female to male ratio was 1:1 with an age range of 24-87 years old. Ninety-five percent of patients were Type 2 diabetics with uncontrolled glucose levels. Majority of the patients are Wagner IV on presentation. Among comorbidities, 6% of the population (n=35) had cardiovascular disease, 18% (n=115) had hypertension, 4% (n=24) had cerebrovascular disease, 28% (n=177) had sepsis and 13% (n=79) had pneumonia at the time of admission. Forty-six percent received purely medical management with intravenous antibiotics, 22% percent received antibiotics and had concomitant debridement, while amputation was performed in forty-one percent of cases. Eighty-five percent (n=545) were discharged, 15% (n=93) died, and the average length of hospital stay was 8 days. The most common cause of mortality was sepsis while the most common reason for prolonged hospitalization is delayed scheduling, lack of blood, and delayed cardiopulmonary clearance.
CONCLUSIONS: After the revision of the DM Foot Protocol, the team achieved its goal of decreasing the mortality rate from 11% to 8%. Amputation rate remains high at 41% overall. The length of hospitalization was statistically higher (p=.026) after the revision of the protocol. This study proposes a revision of the DM Foot Protocol and includes recommendations to further improve the multidisciplinary management of these cases.
KEYWORDS: diabetic foot infection; outcome; interdepartmental approach; management; multidisciplinary