Diyabetik ayak gelişmiş olgularda amputasyon gerekliliğini belirleyen faktörlerin retrospektif olarak incelenmesi
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Date
2012-02-24
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Uludağ Üniversitesi
Abstract
Diyabetik ayak enfeksiyonu diyabetin kronik fakat önlenebilir komplikasyonlarından biridir. Kontrol altına alınamayan enfeksiyonlar ekstremite amputasyonuyla sonuçlanabildiği için çok önemli sosyoekonomik sorunlara yol açmaktadır. Bu çalışmada diyabetik ayak gelişen diabetes mellituslu hastalarda mikro ve makrovasküler komplikasyonlar, A1C düzeyi, osteomiyelit varlığı, üreyen mikroorganizma sayısı ve verilen antibiyoterapi gibi parametrelerle amputasyona gidiş arasındaki ilişkiyi değerlendirmeyi amaçladık. 2008-2011 tarihleri arasında diyabetik ayak enfeksiyonu nedeniyle tedavi gören ve yara kültürlerinde üreme olan 45 hastanın verileri retrospektif olarak incelendi. Oluşturulan hasta değerlendirme formuna bilgiler kaydedildi. Hastalarda amputasyona gidiş ile diyabet yaşı, A1C düzeyleri, cinsiyet, oral antidiyabetik ilaç ya da insülin kullanımı, mikrovasküler komplikasyonların varlığı, diyabetik ayak öyküsü, amputasyon öyküsü, üreyen mikroorganizma sayısı gibi parametreler arasında anlamlı istatistiksel fark görülmedi ancak ileri hasta yaşı, makrovasküler komplikasyon varlığı ve osteomiyelit varlığı ile anlamlı istatistiksel ilişki tespit edildi. İleri hasta yaşı, makrovasküler komplikasyon ve osteomiyelit varlığı diyabetik ayak ülserli hastalarda amputasyona gidiş için önemli risk faktörleri olarak gözükmektedir. Diyabetiklerde, ayak ülserlerine enfeksiyon eklenmeden ve osteomiyelit gelişmeden erken tanı konulup tedavisi gerçekleştirilmelidir. Klinisyenlerin diyabetik ayaklı hastalarda bu parametreleri değerlendirerek, erken ve agresif tedaviye başlamalarının amputasyon oranlarında azalma sağlayacağı düşünülmektedir.
Diabetic foot infection is a chronic but a preventable complication of diabetes. Uncontrolled infections cause major socio-economic problems because they can end up with extremity amputations. In this study we aimed to evaluate the relation between undergoing amputation and patients age, diabetic age, diabetic treatment, presence of micro and macrovascular complications, A1C level, history of diabetic foot and amputation, presence of osteomyelitis, number of causative microorganism and antibiotic treatment. We inspected files of 45 patients retrospectively who was treated for diabetic foot infection with positive bacterial culture between 2008-2011. Data was recorded in previously prepared patient evaluation forms. Relation between amputation and age of diabetes, A1C level, sex, treatment with insulin or oral antidiabetic agents, presence of microvascular complications, history of diabetic foot, history of amputation, number of causative microorganism was not statistically significant. However, relationship between amputation and older age, presence of macrovascular complications (coronary artery disease, peripheral artery disease), presence of osteomyelitis was statistically significant. Older age, presence of macrovascular complications and osteomyelitis seems to be an important risk factor for amputation in patients with diabetic foot ulcer. Diabetic foot ulcers should be promtly treated before the development of osteomyelitis and complicating infections. Considering these parameters in patients with diabetic foot, initiation of prompt and agressive treatment can reduce amputation rates.
Diabetic foot infection is a chronic but a preventable complication of diabetes. Uncontrolled infections cause major socio-economic problems because they can end up with extremity amputations. In this study we aimed to evaluate the relation between undergoing amputation and patients age, diabetic age, diabetic treatment, presence of micro and macrovascular complications, A1C level, history of diabetic foot and amputation, presence of osteomyelitis, number of causative microorganism and antibiotic treatment. We inspected files of 45 patients retrospectively who was treated for diabetic foot infection with positive bacterial culture between 2008-2011. Data was recorded in previously prepared patient evaluation forms. Relation between amputation and age of diabetes, A1C level, sex, treatment with insulin or oral antidiabetic agents, presence of microvascular complications, history of diabetic foot, history of amputation, number of causative microorganism was not statistically significant. However, relationship between amputation and older age, presence of macrovascular complications (coronary artery disease, peripheral artery disease), presence of osteomyelitis was statistically significant. Older age, presence of macrovascular complications and osteomyelitis seems to be an important risk factor for amputation in patients with diabetic foot ulcer. Diabetic foot ulcers should be promtly treated before the development of osteomyelitis and complicating infections. Considering these parameters in patients with diabetic foot, initiation of prompt and agressive treatment can reduce amputation rates.
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Keywords
Diyabetik ayak, Osteomiyelit, Ampütasyon, Diabetic foot, Osteomyelitis, Amputation
Citation
Durgun, O. vd. (2012). "Diyabetik ayak gelişmiş olgularda amputasyon gerekliliğini belirleyen faktörlerin retrospektif olarak incelenmesi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 38(2), 59-62.