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Retrospective cohort study evaluating the incidence of diabetic foot infections among hospitalized adults with diabetes in the United States from 1996-2010

  • Bryson M. Duhon
    Affiliations
    Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX

    Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX

    University Health System, San Antonio, TX
    Search for articles by this author
  • Elizabeth O. Hand
    Affiliations
    Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX

    Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX

    University Health System, San Antonio, TX
    Search for articles by this author
  • Crystal K. Howell
    Affiliations
    Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX

    Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
    Search for articles by this author
  • Kelly R. Reveles
    Correspondence
    Address correspondence to Kelly R. Reveles, PharmD, PhD, BCPS, The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, 7703 Floyd Curl Dr, MSC-6220, San Antonio, TX, 78229-3900.
    Affiliations
    Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX

    Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX
    Search for articles by this author
Published:November 03, 2015DOI:https://doi.org/10.1016/j.ajic.2015.09.012

      Highlights

      • We compared national trends of diabetic foot infection in the United States.
      • We identified independent risk factors for diabetic foot infection in discharged diabetic adults.
      • Diabetic foot infection incidence among hospitalized adults declined from 1996-2010.
      • Complications, including amputation, in hospitalized adults declined among diabetic foot infection adults.

      Background

      The prevalence of diabetes has increased over the last 2 decades; however, the national incidence of diabetic foot infections (DFIs) in the United States is unknown. We sought to determine national trends in DFIs among hospitalized adults in the United States over 15 years.

      Methods

      This was a retrospective cohort study of the U.S. National Hospital Discharge Survey from 1996-2010. Adult patients with a principal diagnosis of foot infection and a secondary diagnosis of diabetes were identified using ICD-9-CM codes. Incidence was defined as DFI discharges per 100 diabetes discharges. Independent risk factors for DFI among diabetics were identified using multivariable logistic regression.

      Results

      These data represent 1,059,552 DFI discharges over the study period. The incidence of DFI decreased from 1996 (2.3 DFIs/100 diabetes discharges) to 2010 (1.1 DFI/100 diabetes discharges). The proportion of patients experiencing lower-extremity amputation declined from 33.2% in 1996 to 17.1% in 2010. Peripheral vascular disease (odds ratio [OR], 2.89; 95% confidence interval [CI], 2.87-2.91), peripheral neuropathy (OR, 2.62; 95% CI, 2.60-2.64), and male sex (OR, 1.67; 95% CI, 1.66-1.68) were the leading risk factors for DFI.

      Conclusion

      The incidence of DFI among hospitalized adults in the United States declined by more than half from 1996-2010.

      Key Words

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      References

        • Centers for Disease Control and Prevention (CDC)
        Increasing prevalence of diagnosed diabetes–United States and Puerto Rico, 1995-2010.
        MMWR Morb Mortal Wkly Rep. 2012; 6: 918-921
      1. Centers for Disease Control and Prevention. National diabetes statistics report, 2014. 2014. Available from: http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed June 16, 2015.

        • Li Y.
        • Burrows N.R.
        • Gregg E.W.
        • Albright A.
        • Geiss L.S.
        Declining rates of hospitalization for nontraumatic lower-extremity amputation in the diabetic population aged 40 years or older: U.S., 1988-2008.
        Diabetes Care. 2012; 35: 273-277
        • Dennison C.
        • Pokras R.
        Design and operation of the National Hospital Discharge Survey: 1988 redesign.
        Vital Health Stat 1. 2000; : 1-42
        • Ali M.K.
        • Bullard K.M.
        • Saaddine J.B.
        • Cowie C.C.
        • Imperatore G.
        • Gregg E.W.
        Achievement of goals in U.S. diabetes care, 1999-2010.
        N Engl J Med. 2013; 368: 1613-1624
        • Tascini C.
        • Piaggesi A.
        • Tagliaferri E.
        • Iacopi E.
        • Fondelli S.
        • Tedeschi A.
        • et al.
        Microbiology at first visit of moderate-to-severe diabetic foot infection with antimicrobial activity and a survey of quinolone monotherapy.
        Diabetes Res Clin Pract. 2011; 94: 133-139
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2004; 27: S5-S10
        • American Diabetes Association
        Standards of medical care in diabetes--2010.
        Diabetes Care. 2010; 33: S11-S61
        • Gabir M.M.
        • Hanson R.L.
        • Dabelea D.
        • Imperatore G.
        • Roumain J.
        • Bennett P.H.
        • et al.
        The 1997 American Diabetes Association and 1999 World Health Organization criteria for hyperglycemia in the diagnosis and prediction of diabetes.
        Diabetes Care. 2000; 23: 1108-1112
        • Margolis D.J.
        • Jeffcoate W.
        Epidemiology of foot ulceration and amputation: can global variation be explained?.
        Med Clin North Am. 2013; 97: 791-805
        • Selvin E.
        • Parrinello C.M.
        • Sacks D.B.
        • Coresh J.
        Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010.
        Ann Intern Med. 2014; 160: 517-525
        • Lipsky B.A.
        • Berendt A.R.
        • Cornia P.B.
        • Pile J.C.
        • Peters E.J.
        • Armstrong D.G.
        • et al.
        Executive summary: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.
        Clin Infect Dis. 2012; 54: 1679-1684
        • Adler A.I.
        • Boyko E.J.
        • Ahroni J.H.
        • Smith D.G.
        Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers.
        Diabetes Care. 1999; 22: 1029-1035
        • Ylitalo K.R.
        • Sowers M.
        • Heeringa S.
        Peripheral vascular disease and peripheral neuropathy in individuals with cardiometabolic clustering and obesity: national Health and Nutrition Examination Survey 2001-2004.
        Diabetes Care. 2011; 34: 1642-1647
        • Ndip A.
        • Lavery L.A.
        • Boulton A.J.
        Diabetic foot disease in people with advanced nephropathy and those on renal dialysis.
        Curr Diab Rep. 2010; 10: 283-290
        • Dinh T.
        • Veves A.
        The influence of gender as a risk factor in diabetic foot ulceration.
        Wounds. 2008; 20: 127-131
        • Chin M.H.
        • Cook S.
        • Drum M.L.
        • Jin L.
        • Guillen M.
        • Humikowski C.A.
        • et al.
        Improving diabetes care in midwest community health centers with the health disparities collaborative.
        Diabetes Care. 2004; 27: 2-8
        • Egede L.E.
        • Gebregziabher M.
        • Hunt K.J.
        • Axon R.N.
        • Echols C.
        • Gilbert G.E.
        • et al.
        Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes.
        Diabetes Care. 2011; 34: 938-943