Ndosi M, et al. - This prospective observational study was performed to ascertain clinical outcomes and investigate prognostic factors associated with ulcer healing in people with a clinically infected diabetic foot ulcer. At 12 months, clinical outcomes for people with an infected diabetic foot ulcer were generally poor. The data confirmed the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.

• The researchers performed a multicentre, prospective, observational study.
• They reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy.
• They obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death from participants’ notes.
• At 6 and 12 months, they estimated the cumulative incidence of healing, adjusted for lower extremity amputation and death using a competing risk analysis.
• The relationship between baseline factors and healing incidence was explored.

• After culture of the index ulcer, 45/299 participants (15.1%) had died in the first year.
• In 136 participants (45.5%), the ulcer had healed but recurred in 13 (9.6%).
• The researchers recorded an ipsilateral lower extremity amputation in 52 (17.4%) and revascularization surgery in 18 participants (6.0%).
• A lower incidence of healing was observed among participants with an ulcer present for ~2 months or more had (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥ 2 (hazard ratio 0.37, 95% CI 0.25 to 0.55).
• A higher incidence of healing was found in participants with a single ulcer on their index foot compared to those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).