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Beitragstitel Failure of glycaemic normalisation after surgery for diabetic foot infections – associated with potential clinical failures?
Beitragscode P59
Autoren
  1. Céline Saphena Moret Universitätsklinik Balgrist Vortragender
  2. Felix Waibel Universitätsklinik Balgrist
  3. Madlaina Schöni Universitätsklinik Balgrist
  4. Martin Berli Balgrist University Hospital
  5. Bettina Liechti
  6. Ilker Uçkay Universitätsklinik Balgrist
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Introduction: A persistently elevated glycaemia postoperatively might influence the success of the surgical management of diabetic foot infections (DFI).

Methods: In this case-control study using a multivariate Cox regression model, patients undergoing surgical treatment for a DFI with and without clinical failure were compared. The glycaemia, among other factors, were analysed at admission as well as at Day 3 and 7 after postoperatively.

Results: One thousand and thirteen cases of DFI, occurring in 586 adult patients (mean age, 67 years) among which 148 cases (15%) had type I diabetes, 882 (87%) osteomyelitis and 572 (56%) revascularisation procedures, underwent a median of one surgical intervention with a median antibiotic therapy duration of 21 days. Diabetes counselling was implemented in 195 cases (19%) (median of 1 session; range, 0-8 sessions). At the same time, all patients were equally followed by internal medicine physicians. At admission, glycemia derailment was observed in 110 cases (11%) with a median admission glycaemia and serum HbA1c values of 7.9 mmol /l and 7.6%, respectively. On postoperative Day 3, glycemia had normalized in 352 (35%) and on Day 7, in 321 (32%) cases. The glycemia had entirely normalized in only 47 cases (13%) until the end of hospitalisation. Overall, 255 DFI episodes (255/1013; 25%) failed and required revision surgery or reiteration antibiotic treatment. In the multivariate analysis, neither the initial HbA1c value, nor the number of diabetes counselling sessions or the normalisations of daily glycaemic levels at Day 3, Day 7, or both, influenced the incidence of clinical failures.

Conclusions: Among all DFI cases, only 13% showed a normalisation of glycaemia at both time points postoperatively. If glycaemic normalisation occurred, it happened on Day 3, without further improvement thereafter. A rapid postoperative normalisation of glycemia does not influence the failure risk of a surgical treatment for a DFI.