Impactos socioeconômicos da infecção do pé diabético

Abstract

Diabetes mellitus (DM) is a serious, progressive and often neglected disease. Diabetic foot infection (IPD) is one of the main and most complex complications observed in patients with DM. The objective of this study was to evaluate the socioeconomic impacts of the treatment of patients and to describe the microorganisms that cause diabetic foot infections in a tertiary referral service in the State of Espírito Santo. It is a retrospective cohort based on the analysis of medical records for specific procedures (amputations, antimicrobial therapy) and costs for the components: hospitalization, material and medication, antibiotic therapy, surgical room and procedures. Quality of life, return to daily and work activities and retirement were also evaluated. The data were distributed according to the PEDIS classification (perfusion, extension, deep, infection, sensibility) at the admission of patients to allow a comparison between those patients classified as PEDIS 2, 3 or 4. Of the 46 patients enrolled in the study, 24 % were classified as PEDIS 2, 39% as PEDIS 3 and 37% as PEDIS 4. An increase of at least six times in the cost of managing patients classified as 3 (R$ 34,610.66) PEDIS 4 (R$ 48,416.71) in relation to those classified as PEDIS 2 (R$ 5,361.94). Among the components evaluated, the expenditures attributed to the "hospitalization" component with the greatest weight, with 52.2% of the total, followed by operating room (20.3%) and materials and medicines (13.9%). There is a high rate of amputations already in the first hospitalization, 56%, with 61% of them minor amputation. Twenty-two patients were readmitted, most (63%) of them precociously for plastic surgery, however 31% returned to the hospital to undergo larger amputations. After the surgical treatment, 15% were retired and started to receive benefit from the Government. According to the own patients' statement, 59% became totally or partially dependent for performing basic daily activities after amputation. In this way, we can highlight an increase in the economic and social cost of conducting more severe cases (PEDIS 3 and 4) in relation to those less complexes, such as PEDIS 2.