The association of chronic, enhanced immunosuppression with outcomes of diabetic foot infections

Abstract

Abstract We investigated if a chronic, enhanced immunosuppressed condition, beyond the immunodeficiency related to diabetes, is associated with clinical failures after combined surgical and medical treatment for diabetic foot infection (DFI). This is a case‐control cohort study in a tertiary centre for diabetic foot problems, using case‐mix adjustments with multivariate Cox regression models. Among 1013 DFI episodes in 586 patients (median age 67 years; 882 with osteomyelitis), we identified a chronic, enhanced immune‐suppression condition in 388 (38%) cases: dialysis (85), solid organ transplantation (25), immune‐suppressive medication (70), cirrhosis (9), cancer chemotherapy (15) and alcohol abuse (243). Overall, 255 treatment episodes failed (25%). By multivariate analysis, the presence (as compared with absence) of chronic, enhanced immune‐suppression was associated with a higher rate of clinical failures in DFI cases (hazard ratio 1.5, 95% confidence interval 1.1–2.0). We conclude that a chronic, enhanced immune‐suppressed state might be an independent risk factor for treatment failure in DFI. Validation of this hypothesis could be useful information for both affected patients and their treating clinicians.

Keywords

• clinical failures
• diabetic foot infection
• enhanced immunosuppression
• epidemiology
• risk factors