Frontiers in endocrinology · 2026
Analysis of infection characteristics and clinical predictive indicators of different bacterial diabetic foot in Yunnan area.
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Zhu Rong, Mei Keqiang, Liu Zehui, Ma Lijuan, Feng Shiyu, Zhao Yaping, Chen Lixin, Wang Zizhou, Ran Zhenqin, Yang Rong, Han Rui
Аннотация
OBJECTIVES: To explore the infection characteristics of different bacterial diabetic foot (DF) in Yunnan area, and to provide reference basis and clinical predictive indicators for individualized treatment of patients with diabetic foot infection (DFI) in this region.
METHODS: A total of 194 local permanent DF patients admitted to the Department of Endocrinology of our hospital from January 2023 to May 2024 were selected. The incidence and drug resistance of DFI were analyzed. Based on bacterial Gram staining as the reference standard, patients were divided into the single-strain Gram-positive bacterial infection group (G+, n=28) and the single-strain Gram-negative bacterial infection group (G-, n=28), and their clinical data were compared. According to the IWGDF/IDSA 2023 grading criteria, patients were divided into the DF without infection group (n=27) and the DFI group (n=167), and their clinical data were compared. Grading was independently performed by two qualified clinicians. Discrepancies were adjudicated by a third senior physician to ensure objectivity. Logistic regression was used to analyze the risk factors for DF complicated with infection, and receiver operating characteristic (ROC) curves were further drawn when statistically significant.
RESULTS: Among 194 patients, 116 underwent culture of foot ulcer tissue secretions, of which 71 had positive pathogen culture results and 45 had negative results, with a bacterial detection rate of 61.20%. The most common pathogen of bacterial diabetic foot in Yunnan area was Staphylococcus aureus, followed by Escherichia coli. Staphylococcus aureus showed high resistance to penicillin, clindamycin, and erythromycin; Escherichia coli showed high resistance to ampicillin, cefazolin, doxycycline, and compound sulfamethoxazole. The course of diabetic foot in the G+ group was longer than that in the G- group, and the number of smokers in the G+ group was higher than that in the G- group, with statistically significant differences (P < 0.05). Logistic regression analysis showed that male gender, fibrin degradation product (FDP), D-dimer, prothrombin time (PT), fibrinogen (FIB), and γ-glutamyl transpeptidase (γ-GT) were independent risk factors for DF complicated with infection. ROC curve analysis showed that the combination of D-dimer + FDP + FIB had the largest area under the curve (AUC) (0.7848, 95% CI 0.7031-0.8666) for predicting DF complicated with infection, with a sensitivity of 57.58% and a specificity of 92.31%. Conclusion The combination of D-dimer + FDP + FIB can be used as an auxiliary exclusion tool for early DFI in Yunnan area, with high specificity (92.31%) and certain clinical practical value.
METHODS: A total of 194 local permanent DF patients admitted to the Department of Endocrinology of our hospital from January 2023 to May 2024 were selected. The incidence and drug resistance of DFI were analyzed. Based on bacterial Gram staining as the reference standard, patients were divided into the single-strain Gram-positive bacterial infection group (G+, n=28) and the single-strain Gram-negative bacterial infection group (G-, n=28), and their clinical data were compared. According to the IWGDF/IDSA 2023 grading criteria, patients were divided into the DF without infection group (n=27) and the DFI group (n=167), and their clinical data were compared. Grading was independently performed by two qualified clinicians. Discrepancies were adjudicated by a third senior physician to ensure objectivity. Logistic regression was used to analyze the risk factors for DF complicated with infection, and receiver operating characteristic (ROC) curves were further drawn when statistically significant.
RESULTS: Among 194 patients, 116 underwent culture of foot ulcer tissue secretions, of which 71 had positive pathogen culture results and 45 had negative results, with a bacterial detection rate of 61.20%. The most common pathogen of bacterial diabetic foot in Yunnan area was Staphylococcus aureus, followed by Escherichia coli. Staphylococcus aureus showed high resistance to penicillin, clindamycin, and erythromycin; Escherichia coli showed high resistance to ampicillin, cefazolin, doxycycline, and compound sulfamethoxazole. The course of diabetic foot in the G+ group was longer than that in the G- group, and the number of smokers in the G+ group was higher than that in the G- group, with statistically significant differences (P < 0.05). Logistic regression analysis showed that male gender, fibrin degradation product (FDP), D-dimer, prothrombin time (PT), fibrinogen (FIB), and γ-glutamyl transpeptidase (γ-GT) were independent risk factors for DF complicated with infection. ROC curve analysis showed that the combination of D-dimer + FDP + FIB had the largest area under the curve (AUC) (0.7848, 95% CI 0.7031-0.8666) for predicting DF complicated with infection, with a sensitivity of 57.58% and a specificity of 92.31%. Conclusion The combination of D-dimer + FDP + FIB can be used as an auxiliary exclusion tool for early DFI in Yunnan area, with high specificity (92.31%) and certain clinical practical value.