Methods: We retrospectively reviewed 64 patients who suffered from Fontaine classification stage IV of CLI and were hospitalized at our hospital to perform revascularization during two years from 2012 to 2014. We collected data of isolated microorganism (>104 cfu/ml) from surface or biopsy sample, the Society for Vascular Surgery lower extremity threatened limb (SVS WIfI) classification associated with wound, ischemia, and foot infection, and outcome.
Results: The rate of severe grade of wound and ischemia before revascularization was 7.8% (5 cases) and 39.1% (25 cases), respectively. There was no case of severe grade of infection with the sign of SIRS. The number of the cases with high risk of amputation by the SVS WIfI classification after revascularization was significantly lower than that before revascularization (16/64, 25.0% vs. 30/64, 55.6%; p<0.001). Amputation was performed for 15 patients (23.4%) (at toes, 10 cases; below the knee, 3 case; above the knee, 2 cases). A total of 92 bacterial strains were isolated from ulcer of 42 patients . The most common isolate is Staphylococcus aureus (27 strains, 29.3%): 12 strains (13.0%) of methicillin-sensitive S. aureus (MSSA) and 15 strains (16.3%) of methicillin-resistant S. aureus(MRSA). There was no difference of the rate of severe grade of ischemia after revascularization between the case with MSSA detection and the case without MSSA detection (8.3%, 1/12 vs. 7.7%, 4/52; p=0.45); however there was a significant difference of the rate of severe grade of wound between two groups (25.0%, 3/12 vs. 3.8%, 2/52; p=0.04). The detection of MSSA was a significant risk factor for amputation (50.0%, 6/12 vs. 9/52, 17.3%; p=0.03). There was no relation between MRSA detection and the rate of severe grade of wound (6.7%, 1/15 vs. 8.2%, 4/49; p=0.46) or the rate of case required amputation (26.6%. 4/15 vs. 16.3%, 8/19; p=0.74).
Conclusion: Foot infection with CLI caused by MSSA was associated with the severity of wound and one of risk factors of amputation after revascularization.
I. Imagama, None
T. Koriyama, None
T. Kojyo, None
A. Shigemi, None
K. Tokuda, None
Y. Imoto, None
J. Nishi, None
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