J Korean Foot Ankle Soc.  2024 Dec;28(4):157-164. 10.14193/jkfas.2024.28.4.157.

Comparative Analysis of Pathogen Detection and Eradication in Single vs. Revision Amputation Cases of Diabetic Foot Patients

• Kwon KY
• Jeong HH
• Lee JW

• KMID: 2562453
• DOI: http://doi.org/10.14193/jkfas.2024.28.4.157

Abstract

Purpose
This study examined the differences in pathogen survival between single and revision amputations in diabetic foot infections. Current research lacks data on the postoperative pathogen profiles, particularly in cases involving repeated surgeries, making this study essential for targeted infection management.
Materials and Methods
The medical records of 168 diabetic foot ulcer patients treated at a single center, divided into single (n=113) and revision amputation groups (n=55) were analyzed retrospectively. Preoperative deep tissue samples and postoperative wound swab samples were collected to analyze the pathogens. The C-reactive protein (CRP) levels were measured as an inflammation marker. The pathogen diversity, frequency, and survival rate were compared. The ‘survival rate’ was defined as the frequency of postoperative persistence of pathogens relative to the preoperative detection frequency.
Results
Revision amputation cases showed a higher diversity (p=0.0029) and persistence of pathogens, with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, and most other detected pathogens displaying higher survival rates. The CRP levels generally decreased postoperatively, but the variability was more pronounced in the revision group, suggesting that CRP may not consistently correlate with infection control in complex cases.
Conclusion
These findings revealed significant differences in the pathogen profiles between single and revision amputations, with revision cases facing more significant infection challenges because of the higher resistant pathogen persistence.

Keyword

Diabetic foot; Pathogen; Amputation; C-reactive protein