From Ulcer to Infection: An Update on Clinical Practice and Adjunctive Treatments of Diabetic Foot Ulcers

Diabetic foot ulcers are of neurogenic or angiogenic origin. In both cases they pose a serious health threat because their treatment is difficult and in many cases is ineffective. A serious complications in the treatment of this disease are caused by microorganism infections that are resistant to antibiotics. Hence the search for other effective healings of diabetic foot ulcers. One solution is to use bee honey for this purpose. The clinical studies presented in the work prove that the use of honey dressings in diabetic foot ulcers provide very beneficial effects, better and faster achievable than in the case of preparations generally used in clinical practice. For this reason, bee honey can be successfully applied in the treatment of diabetic foot ulcers, both of angiogenic and neurogenic origin, at different stages of development, including gangrenous processes.

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MON-626 Frequency and Associated Factors with Multidrug-Resistant Organism Infection in Diabetic Foot Ulcers in a Peruvian Public Hospital

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1209 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Marlon Augusto Yovera-Aldana ◽

Liset Paola Sifuentes ◽

Delia Cruz-Estacio ◽

Diana Consuelo Flores ◽

Lucy Nelly Damas-Casani

Keyword(s):

Clinical Practice ◽

Diabetic Foot ◽

Associated Factors ◽

Public Hospital ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Bivariate Analysis ◽

Resistant Organism ◽

Diabetic Foot Ulcers ◽

International Expert

Abstract Objective: To determine the frequency and associated factors with multidrug-resistant organism (MDRO) infection among patients with diabetic foot ulcers in a Peruvian Public Hospital. Materials and methods. Cross-sectional survey was conducted from January 2017 -December 2018 at National Hospital in Lima Perú. Ulcers with clinical signs of infection (erythema, edema, pain, purulent exudate) according Infectious Diseases Society of America clinical practice guideline were included1. Wounds with only skin involvement were excluded. On admission, specimens for culture were obtained after cleansing and debriding of the wound. Samples were promptly sent to the microbiology laboratory for culture using appropriate transport media. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 automated system (BioMérieux Laboratory, Argentina). Multidrug-resistant organisms were identified according to the recommendations of International Expert Proposal2. Prevalence ratios derived from bivariate analysis are given with their 95% CI, which was performed to study factors associated with the presence of multidrug-resistant bacteria; and a multivariate analysis with a lineal model to associated variables found in the bivariate analysis. This study has the approval of the Research Ethics Committee of the María Auxiliadora Hospital. Results Among 153 selected subjects, 75% were male, with an average age of 59 yo, 70% had ≥10 years of diabetes duration and only 16% had HbA1C <7%. A frequency of 85% of patients with MDRO infection was found and was associated with minor amputation RP 1.18 (95% CI 1.01-1.44) and with hospitalization time of ≥ 28 days RP 1.21 (95% CI 1.03-1.30). Conclusion. 6 of 7 patients have MDRO infection among patients with diabetic foot ulcers and are associated with the occurrence of minor amputation and hospitalization time ≥ 28 days. References 1. Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-73. 2. Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

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Knee-High Devices Are Gold in Closing the Foot Ulcer Gap: A Review of Offloading Treatments to Heal Diabetic Foot Ulcers

Medicina ◽

10.3390/medicina57090941 ◽

2021 ◽

Vol 57 (9) ◽

pp. 941

Author(s):

Peter A. Lazzarini ◽

Gustav Jarl

Keyword(s):

Clinical Practice ◽

Diabetic Foot ◽

Gold Standard ◽

Disease Burden ◽

Foot Ulcers ◽

Supporting Evidence ◽

Diabetic Foot Ulcers ◽

The Common ◽

Common Barriers ◽

Global Disease Burden

Diabetic foot ulcers (DFU) are a leading cause of the global disease burden. Most DFUs are caused, and prolonged, by high plantar tissue stress under the insensate foot of a person with peripheral neuropathy. Multiple different offloading treatments have been used to try to reduce high plantar tissue stress and heal DFUs, including bedrest, casting, offloading devices, footwear, and surgical procedures. The best offloading treatments are those that balance the benefits of maximizing reductions in high plantar tissue stress, whilst reducing the risks of poor satisfaction, high costs and potential adverse events outcomes. This review aimed to summarize the best available evidence on the effects of offloading treatments to heal people with DFUs, plus review their use in clinical practice, the common barriers and solutions to using these treatments, and discuss promising emerging solutions that may improve offloading treatments in future. Findings demonstrate that knee-high offloading devices, non-removable or removable knee-high devices worn for all weight-bearing activities, are the gold standard offloading treatments to heal most patients with DFU, as they are much more effective, and typically safer, quicker, and cheaper to use compared with other offloading treatments. The effectiveness of offloading treatments also seems to increase when increased offloading mechanical features are incorporated within treatments, including customized insoles, rocker-bottom soles, controlled ankle motion, and higher cast walls. However, in clinical practice these gold standard knee-high offloading devices have low rates of prescription by clinicians and low rates of acceptance or adherence by patients. The common barriers resulting in this low use seem to surround historical misperceptions that are mostly dispelled by contemporary evidence. Further, research is now urgently required to close the implementation gap between the high-quality of supporting evidence and the low use of knee-high devices in clinical practice to reduce the high global disease burden of DFU in future.

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