chapter  6
19 Pages

MRSA in the Diabetic Foot /

Lee C. Rogers, Nicholas J. Bevilacqua, and David G. Armstrong
ByDavid G. Armstrong

David G. Armstrong Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, U.S.A.


Diabetic foot problems are a major burden on health care resources and

come at great costs. Diabetic foot ulcers (DFUs) will affect up to 25% of

people with diabetes during their lifetime. DFUs/diabetic foot infections

(DFIs) are the most common reason for hospitalization among diabetic

patients in the United States (1). Hospital length of stay is 59% longer for

diabetic patients with ulcers when compared to those without ulcers (2).

Foot ulcers and amputations were estimated to cost the U.S. health care

system $30 billion in 2007 (3). Foot ulcers are the antecedent event in

84% of diabetic lower extremity amputations (LEAs) (4). More than half

of the approximately 120,000 nontraumatic amputations performed each

year are on people with diabetes, making diabetes the leading cause of

nontraumatic amputations (5). The Centers for Disease Control 1999

Surveillance Summary for nontraumatic amputations revealed that LEAs

increased by 24% between 1983 and 1996. There were 10.2 LEAs per

1000 diabetic patients (6). Infection precedes 59% of diabetic amputations

(4). A person with diabetes and one LEA has a 50% chance of developing a

limb-threatening condition on the contralateral limb within two years (7).

Diabetics with foot problems are at increased risk of morbidity and

mortality. Jeffcoate et al. followed 449 diabetic patients with ulcers for