scholarly journals 2,500,000 Troubled Soles: Ten-Year Analysis of Diabetic Foot Infections in the United States

2013 ◽  
Vol 58 (2) ◽  
pp. 558
Author(s):  
Grant H. Skrepnek ◽  
David G. Armstrong ◽  
Joseph L. Mills
Keyword(s):  
United States ◽  
Diabetic Foot ◽  
The United States ◽  
Diabetic Foot Infections

scholarly journals A multicenter randomized placebo controlled trial of rifampin to reduce pedal amputations for osteomyelitis in veterans with diabetes (VA INTREPID)

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mary T. Bessesen ◽  
Gheorghe Doros ◽  
Adam M. Henrie ◽  
Kelly M. Harrington ◽  
John A. Hermos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Adjunctive Therapy ◽  
The United States ◽  
Quality Data ◽  
Free Survival ◽  
Primary Hypothesis ◽  
Diabetic Foot Osteomyelitis

Abstract Background The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. Methods/design This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. Discussion VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. Trial registration Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.

Barriers to Prevention and Timely Presentation of Diabetic Foot Ulcers: Perspectives of Patients from a High-risk Urban Population in the United States

2021 ◽  
Vol 32 (3) ◽  
pp. 1554-1565
Author(s):  
Anna Flattau ◽  
Molly L. Tanenbaum ◽  
Jeffrey S. Gonzalez ◽  
Cary Andrews ◽  
Stephanie Twomey ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Diabetic Foot ◽  
Urban Population ◽  
The United States ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers

Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer

2018 ◽  
Vol 108 (6) ◽  
pp. 528-531 ◽  
Author(s):  
Andrew J. Hale ◽  
Emily Vicks ◽  
Mary T. LaSalvia ◽  
John M. Giurini ◽  
Adolf W. Karchmer
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The United States ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections

Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.

scholarly journals Fluoroquinolone prescribing for diabetic foot infections following an FDA Drug Safety Communication for aortic aneurysm risk

2021 ◽  
Author(s):  
Catherine Li ◽  
Nicholas J. Mercuro ◽  
Ryan W. Chapin ◽  
Howard S. Gold ◽  
Christopher McCoy
Keyword(s):  
Aortic Aneurysm ◽  
Drug Safety ◽  
Diabetic Foot ◽  
The United States ◽  
Transitions Of Care ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
Safety Communication ◽  
Diabetic Foot Infections ◽  
Days Of Therapy

In 2018, the United States Food and Drug Administration (FDA) issued a Drug Safety Communication regarding fluoroquinolone-associated aortic aneurysm. This quasi-experimental study assessed antibiotic prescribing for 198 hospitalized patients with diabetic foot infection. Following the warning, median inpatient fluoroquinolone days of therapy (DOT) decreased from 3 to 0 days ( P < 0.001), corresponding with increased beta-lactam DOT and OPAT enrollment. FDA communications may influence antibiotic selection and transitions of care, representing opportunities for antimicrobial stewardship.

scholarly journals Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

2018 ◽  
Vol 12 (05) ◽  
pp. 347-351 ◽  
Author(s):  
Michele Obeid ◽  
Eric Moughames ◽  
Petra Aboulhosn ◽  
Rashad Madi ◽  
Maya Farah ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Middle Eastern ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The United States ◽  
Pseudomonas Spp ◽  
Diabetic Foot Infections ◽  
Amoxicillin Clavulanate ◽  
Susceptibility Profiles

Introduction: Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly Staphylococcus species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative Pseudomonas spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles. Methodology: We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon. Results: Among all isolates, Enterobacteriaceae (42%), Pseudomonas spp. (18.6%) and methicillin-sensitive Staphylococcus aureus (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of Pseudomonas spp. were susceptible to ciprofloxacin and 63.6% of Enterobacteriaceae were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant Staphylococcus aureus (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients. Conclusion: In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.

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