NDLI: Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections.

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Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Fleischer, Adam E. Wrobel, James S. Leonards, Andrea Berg, Scott Evans, Daniel P. Baron, Robert L. Armstrong, David G.
Description	Country affiliation: United States Author Affiliation: Fleischer AE ( Department of Radiology and Surgery, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA. adam.e.fleischer@gmail.com)
Abstract	Our aim was to determine whether post-treatment laboratory values could help to predict the clinical response in patients with advanced diabetic foot infections. One hundred and three consecutive patients hospitalized for moderate or severe diabetic foot infections at a large, university-affiliated hospital were identified and their records retrospectively reviewed. Definitive therapy during each patient's hospital course was defined as any foot surgery when additional major surgery was not anticipated or when a course of deep soft tissue and/or bone culture-specific antibiotics had been initiated. The clinical response was assessed at 90 days after the start of definitive therapy. A poor response was recognized as persistent infection at the initial or a contiguous site or when unplanned revision surgery or amputation was subsequently required. The peripheral white blood cell count, neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels measured shortly after initiating definitive therapy (i.e., post-treatment) were examined for their association with the clinical response using logistic regression models. A total of 38 patients with the complete compliment of laboratory and clinical follow-up aged 59.7 ± 12.3 years with a diabetes duration of 13.3 ± 9.1 years were included. Leukocytosis, defined as a white blood cell count >11,000 cells/µL, observed an average of 3 ± 1.4 days after treatment, was the single most important marker for predicting a poor clinical response, and the only significant study variable in both univariate and multivariate analyses (multivariate odds ratio 9.7, 95% confidence interval 1.0 to 92, p = .048). We conclude that leukocytosis observed shortly after initiating definitive therapy is predictive of an unfavorable clinical response by 90 days.
File Format	HTM / HTML
ISSN	10672516
Issue Number	5
Volume Number	50
e-ISSN	15422224
Journal	The Journal of Foot and Ankle Surgery
Language	English
Publisher	Elsevier
Publisher Date	2011-09-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Discipline General Surgery Diabetic Foot Therapy Leukocytosis Complications Osteomyelitis Soft Tissue Infections Amputation Anti-bacterial Agents Therapeutic Use Blood Sedimentation C-reactive Protein Analysis Cohort Studies Debridement Female Humans Male Middle Aged Multivariate Analysis Neutrophils Metabolism Roc Curve Reoperation Retrospective Studies Sensitivity And Specificity Treatment Outcome Journal Article
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery

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