Microbiological Signatures and Clinical Predictors of Severity in Diabetic Foot Infection.

Authors

Bartosz Molasy, Katarzyna Ewa Kuszewska, Agnieszka Piechowska, Małgorzata Wrzosek

Published in

Polski przeglad chirurgiczny. Volume 98. Issue 3. Pages 1-10. May 26, 2026.

Abstract

<p><strong>Introduction:</strong> Diabetic foot infection (DFI) is a major complication of diabetes associated with high rates of amputation, recurrence, and healthcare utilization. The prognostic interaction between clinical and microbiological markers remains unclear.</p><p><strong>Aim:</strong> The present analysis aimed to characterize clinical, inflammatory, and microbiological predictors of course and resource use in surgically managed DFI.</p><p><strong>Material and methods:</strong> We retrospectively analyzed 121 hospitalizations of 86 patients treated surgically for DFI (2021-2025). Clinical, laboratory, and microbiological variables were assessed in relation to amputation, reamputation, rehospitalization, length of stay (LOS), and mortality.</p><p><strong>Results:</strong> Amputation was performed in 72/121 episodes (59.5%), including 57 minor and 15 major procedures. Reamputation occurred in 13/72 cases (18.1%). Rehospitalization was recorded in 42/86 patients (48.8%). Median LOS was 13 days (IQR 8-21). A total of 227 isolates were obtained, with <em>Enterococcus faecalis</em> (38 isolates, 16.7%) and <em>Staphylococcus aureus</em> (28 isolates, 12.3%) being the most frequent. Polymicrobial infections were present in 75/121 episodes (63%). Neuro-ischemic ulcer phenotype independently predicted reamputation (aOR 3.72; p = 0.036). <em>Staphylococcaceae</em> increased the likelihood of rehospitalization (aOR 3.32; p = 0.014). NLR &gt;5 prolonged LOS by 42%, and <em>Enterococcus</em> spp. by 51%. Repeat hospitalizations showed enrichment of ESBL <em>Klebsiella pneumoniae</em> (5 cases) and HLAR E. faecalis (9 cases).</p><p><strong>Conclusions: </strong>Ulcer phenotype and systemic inflammatory response were the strongest predictors of adverse outcomes. Microbiology contributed selective yet clinically meaningful prognostic information, particularly regarding <em>Staphylococcaceae</em> and <em>Enterococcus</em> spp.</p>.

PMID:
42439000
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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