THE MANAGEMENT OF DIABETIC FOOT IN THE EMERGENCY

Background:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency

Aims: To define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency

Patients/methods: This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. We investigated socio-demographic, clinical data and treatment of patients hospitalized for diabetic foot.

Results: The mean age of patients was 63.7ans, 92.6% were diabetic type2. 57.4% of lesions were acute (ulcers (37%), wet gangrene (33.3%), dry gangrene (13%),cellulitis (24.1%) and acute Charcot foot (9.3%)), 63% following a trauma and 33.2% due to unsuitable footwear. 81.5% had clinical signs of angiopathy and 64.5% of neuropathy. The lesions were classified: uninfected (9.3%), low (9.3%), moderate (38.8%) and severe (42.6%) according to the IDSA / IWGDF and 0D (46.3%) 3D (18.5%) 3B (7.4%) according to the University of Texas. Staphylococcus aureus was the most germ solved. Antibiotics administered if osteitis was Amoxicillin-clavulanate (57.5%) and Ertapenem (31.5%) in his absence. 14.8% received debridement, 1.9% for revascularization and 83.3% for amputation. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded.

Conclusions: The multidisciplinary management of diabetic foot is paramount. The surgery is common immediately but rarely necessary, medical treatment is the first-line therapy avoiding abusive amputations. Prevention requires the establishment of specialized units.

Summary:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency. This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded.