Evaluation of Adherence to the Oral Antibiotic Treatment in Patients With Diabetic Foot Infection

2021 ◽  
pp. 153473462110573
Author(s):  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Yolanda García-Álvarez ◽  
Mateo López-Moral ◽  
Francisco Javier Álvaro-Afonso ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Soft Tissue ◽  
Antibiotic Treatment ◽  
Diabetic Foot ◽  
Diabetic Patients ◽  
Oral Antibiotic ◽  
Diabetic Foot Infection ◽  
Adherence Scale ◽  
Method Of Evaluation ◽  
Well Level

Introduction: The knowledge about level of adherence to oral antibiotic treatment in diabetic patients with ulcer infection could be essential as a method of evaluation/monitoring of conservative treatment. Aim: To assess the adherence to oral antibiotic treatment in outpatients with diabetic foot infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale. Methods: cross-sectional study was carried out with 46 consecutive patients who had diabetic foot infection (soft tissue or bone infection) and required antibiotic oral treatment at outpatient clinical setting. Medication adherence was tested using the Spanish version of the validated eight-item self-report MMAS-8. Results: patients with diabetic ulcer infection, had well level of adherence to antibiotic medication (7   ±   1.2 vs. 7.4   ±   1.5). Patients with lower level of adherence had lower level of satisfaction with the antibiotic medication. The profile of the patients with lower level of adherence were patients with primary level of education and patient who required more help to take the medication. Conclusion: Patients with diabetic foot infection demonstrated well level of adherence to antibiotic medication, independently of type of infection (soft tissue vs. osteomyelitis) by 8-item structured, self-reported medication adherence scale.

scholarly journals Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

2018 ◽  
Vol 56 (1) ◽  
pp. 3-8
Author(s):  
Dimitrios Velissaris ◽  
Nikolaos-Dimitrios Pantzaris ◽  
Christina Platanaki ◽  
Nikolina Antonopoulou ◽  
Charalampos Gogos
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Diabetic Foot ◽  
Assessment Tool ◽  
Tissue Infection ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Mortality And Morbidity ◽  
Diabetic Foot Infection ◽  
Patients With Diabetes

Abstract Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

Should Treatment of Diabetic Foot Osteomyelitis Be Based on Bone Biopsies?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 73S-74S
Author(s):  
Nima Heidari ◽  
Iris Kwok ◽  
Alexandros Vris ◽  
Alexander Charalambous
Keyword(s):  
Soft Tissue ◽  
Antibiotic Treatment ◽  
Diabetic Foot ◽  
Level Of Evidence ◽  
Tissue Samples ◽  
Diabetic Foot Infection ◽  
Bone Biopsies ◽  
Diabetic Foot Osteomyelitis ◽  
Superficial Soft Tissue

Recommendation: Yes. Bone biopsies play both a crucial diagnostic and interventional role in the management of diabetic foot infection. Although bone biopsies are not required in every case of diabetic foot infection, their most important role is in guiding accurate antibiotic treatment, as they provide more accurate microbiological information than superficial soft tissue samples in patients with diabetic foot osteomyelitis. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

scholarly journals Randomized Prospective Controlled Trial of Recombinant Granulocyte Colony-Stimulating Factor as Adjunctive Therapy for Limb-Threatening Diabetic Foot Infection

2001 ◽  
Vol 45 (4) ◽  
pp. 1094-1098 ◽  
Author(s):  
Fausto de Lalla ◽  
Giampietro Pellizzer ◽  
Marco Strazzabosco ◽  
Zeno Martini ◽  
Giovanni Du Jardin ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Adjunctive Therapy ◽  
Standard Treatment ◽  
Diabetic Patients ◽  
Cumulative Number ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Diabetic Foot Infection ◽  
Number Of Patients ◽  
Stimulating Factor

ABSTRACT Adult diabetic patients admitted to our Diabetes Center from September 1996 to January 1998 for severe, limb-threatening foot infection were consecutively enrolled in a prospective, randomized, controlled clinical study aimed at assessing the safety and efficacy of recombinant human granulocyte colony-stimulating factor (G-CSF) (lenograstim) as an adjunctive therapy for the standard treatment of diabetic foot infection. Forty patients, all of whom displayed evidence of osteomyelitis and long-standing ulcer infection, were randomized 1:1 to receive either conventional treatment (i.e., antimicrobial therapy plus local treatment) or conventional therapy plus 263 μg of G-CSF subcutaneously daily for 21 days. The empiric antibiotic treatment (a combination of ciprofloxacin plus clindamycin) was further adjusted, when necessary, according to the results of cultures and sensitivity testing. Microbiologic assessment of foot ulcers was performed by both deep-tissue biopsy and swab cultures, performed at enrollment and on days 7 and 21 thereafter. Patients were monitored for 6 months; the major endpoints (i.e., cure, improvement, failure, and amputation) were blindly assessed at weeks 3 and 9. At enrollment, both patient groups were comparable in terms of both demographic and clinical data. None of the G-CSF-treated patients experienced either local or systemic adverse effects. At the 3- and 9-week assessments, no significant differences between the two groups could be observed concerning the number of patients either cured or improved, the number of patients displaying therapeutic failure, or the species and number of microorganisms previously yielded from cultures at day 7 and day 21. Conversely, among this small series of patients the cumulative number of amputations observed after 9 weeks of treatment appeared to be lower in the G-CSF arm; in fact, only three patients (15%) in this group had required amputation, whereas nine patients (45%) in the other group had required amputation (P = 0.038). In conclusion, the administration of G-CSF for 3 weeks as an adjunctive therapy for limb-threatening diabetic foot infection was associated with a lower rate of amputation within 9 weeks after the commencement of standard treatment. Further clinical studies aimed at precisely defining the role of this approach to this serious complication of diabetes mellitus appear to be justified.

scholarly journals Is Every Foot Wound a Diabetic Foot Infection in Diabetic Patients? A Case Of Kaposi Sarcoma

2019 ◽  
Author(s):  
Şevki Çetinkalp ◽  
Sinan Mermer ◽  
İlgen Ertam Sağduyu ◽  
Taner Akalın ◽  
Meltem Işıkgöz Taşbakan
Keyword(s):  
Diabetic Foot ◽  
Kaposi Sarcoma ◽  
Diabetic Patients ◽  
Diabetic Foot Infection

scholarly journals Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection

2012 ◽  
Vol 109 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Shalbha Tiwari ◽  
Daliparthy D. Pratyush ◽  
Balram Gupta ◽  
Awanindra Dwivedi ◽  
Sandeep Chaudhary ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Diabetic Foot ◽  
Vitamin D Supplementation ◽  
Diabetic Patients ◽  
Similar Data ◽  
Diabetic Foot Infection ◽  
Hydroxyvitamin D ◽  
Severe Vitamin ◽  
Diabetic Foot Infections

The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (sd 38·35) v. 50·75 (sd 33·00); P < 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D < 75 nmol/l) was equally common in cases and controls (OR 1·45, 95 % CI 0·8, 3·0; P = 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D < 50 nmol/l) than controls (OR 1·8, 95 % CI 1·1, 3·0; P = 0·02). Risk of severe vitamin D deficiency (25(OH)D < 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95 % CI 2·4, 6·9; P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency ( < 25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies.

scholarly journals Procalcitonin Is a Prognostic Marker of Hospital Outcomes in Patients with Critical Limb Ischemia and Diabetic Foot Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Meloni ◽  
Valentina Izzo ◽  
Laura Giurato ◽  
Enrico Brocco ◽  
Michele Ferrannini ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Hospital Outcomes ◽  
Diabetic Foot Infection ◽  
The Mean

Aim. To evaluate the prognostic role of procalcitonin (PCT) in patients with diabetic foot infection (DFI) and critical limb ischemia (CLI). Materials and Methods. The study group was composed of diabetic patients with DFI and CLI. All patients were treated according to a preset limb salvage protocol which includes revascularization, wound debridement, antibiotic therapy, and offloading. Inflammatory markers, including PCT, were evaluated at admission. Only positive values of PCT, greater than 0.5 ng/ml, were considered. Hospital outcomes were categorized as limb salvage (discharge with preserved limb), major amputation (amputation above the ankle), and mortality. Results. Eighty-six patients were included. The mean age was 67.3±11.4 years, 80.7% were male, 95.1% had type 2 diabetes, and the mean diabetes duration was 20.5±11.1 with a mean HbA1c of 67±16 mmol/mol. 66/86 (76.8%) of patients had limb salvage, 7/86 (8.1%) had major amputation, and 13/86 (15.1%) died. Patients with positive PCT baseline values in comparison to those with normal values showed a lower rate of limb salvage (30.4 versus 93.6%, p=0.0001), a higher rate of major amputation (13 versus 6.3%, p=0.3), and a higher rate of hospital mortality (56.5 versus 0%, p<0.0001). At the multivariate analysis of independent predictors found at univariate analysis, positive PCT was an independent predictor of major amputation [OR 3.3 (CI 95% 2.0-5.3), p=0.0001] and mortality [OR 4.1 (CI 95% 2.2-8.3), p<0.0001]. Discussion. Positive PCT at admission increased the risk of major amputation and mortality in hospital patients with DFI and CLI.

scholarly journals The analysis for time of referral to a medical center among patients with diabetic foot infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng-Wei Lin ◽  
Hui-Mei Yang ◽  
Shih-Yuan Hung ◽  
I-Wen Chen ◽  
Yu-Yao Huang
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Poor Prognosis ◽  
Medical Center ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Diabetic Foot Infection ◽  
The Impact

Abstract Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.

scholarly journals An Analysis of Clinical Characters of Inpatients with Infection in the Department of Endocrinology

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Jianying Zhang
Keyword(s):  
Urinary Tract ◽  
Length Of Stay ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Diabetic Foot ◽  
Glycosylated Hemoglobin ◽  
Antibiotic Use ◽  
Diabetic Patients ◽  
Diabetic Foot Infection ◽  
Per Capita

Objective: To analyze the clinical characters of 812 inpatients with infection in the Department of Endocrinology. Methods: Retrospective exhibition of these patients' clinical characters included undergoing diseases, infectious organs, history illness, blood glucose and glycosylated hemoglobin (HbA1C), biochemical indicators, pathogens training description and results, medical imagines, antibiotic utilization, length of stay and hospital costs, final diagnosis and situations. Results: Non-diabetic patients accounted for 176 (21.67%), who were the cases of untreated well hyperthyroidism, mainly suffered with respiratory tract infection. Diabetic patients accounted for 636 (78.33%). In the type2 diabetes patients 376 (59.12) suffered with urinary tract infection. 192 (30.19%) suffered with respiratory system infection, 124 (19.50%) were accompanied with diabetic foot infection, which had 74 (59.67%) patients with HbA1C＞9.0%.Statistical comparisons showed that the days of antibiotic use and average length of stay in hospital per capita in patients with HbA1C≥8% were more than ones with HbA1C＜8% in those with diabetic infections (P＜0.01) . The days of antibiotic use per capita in patients with HbA1C＞9% were more than ones with HbA1C＜7% in those with diabetic foot infections (P＜0.01). Conclusion: Endocrine diseases lack rigid and effective long-term control, which may result in the complications involved with urinary tract, respiratory tract and infections in other organs. The time of hospitalization per capita and the duration of antibiotic use rise are longer in diabetic patients with poor blood sugar control and diabetic foot infection.

scholarly journals Analysis of Reasons For Readmission of Diabetic Patients: 2015-2019

2022 ◽  
Author(s):  
Junmei Wang ◽  
Jiayao Xiong ◽  
Chao Yang ◽  
Xianshu Jiang ◽  
Min Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glycemic Control ◽  
Influencing Factors ◽  
Diabetic Foot ◽  
Readmission Rate ◽  
Poor Glycemic Control ◽  
Diabetic Patients ◽  
Spearman Correlation ◽  
Diabetic Foot Infection ◽  
Duration Of Diabetes

Abstract Background: Among patients with diabetes who had been hospitalized, 30% had twice or more hospitalisations rate, accounting for more than 50% of total hospitalizations and hospitalization expense. The purpose of our study was to to find available strategies to reduce the readmission rate of diabetics in rural areas.Methods: This retrospective single-center study used the data from Yongchuan Hospital of Chongqing Medical University. The t-test and the chi-square test or Fisher's exact test were used to compare continuous and categorical variables, respectively. We used the Spearman correlation coefficient to examine the relationship between variables. Multiple linear regression was performed to analyze the influencing factors of hospitalisation time, and dummy variables were set for categorical independent variables. Results: There were a total of 1721 readmissions during a five-year period; among them, 829 were females and 892 males. The readmission rate of diabetic patients in the endocrinology department was 32.40%. The age, times of hospitalisation, and duration of all subjects were 64.67 ± 13.82, 2.69 ± 1.41 and 10.60 ± 6.78, respectively. Among all the diabetic patients, type 2 diabetes accounted for 98.55% (n = 1696). Most of the patients were readmitted due to poor glycemic control, infection, edema, dizziness, and weakness, accounting for approximately 56%. During the 5-year period, the majority of readmitted diabetic patients were hospitalized twice. Times of hospitalisation was weakly positively correlated with age (Rho = 0.206, P≤0.001), diabetic duration (Rho = 0.248, P ≤ 0.001) and hospitalisation expenses (Rho = 0.008, P = 0.035) by Spearman correlation analysis. Age, duration of diabetes, systolic blood pressure (SBP), diastolic blood pressure (DBP) and alanine aminotransferase (ALT) were the main factors affecting times of hospitalisation in diabetes patients (all P < 0.05). Compared with current smokers, non-smokers and cessation smokers had high hospitalisations rate (all P for trend < 0.05). When taking diabetic foot infection as a reference, edema was more accountable than diabetic foot infection for hospitalisation times, which was statistically significant (P for trend = 0.048).Conclusion: Age, duration of diabetes and hospitalisation costs were positively correlated with times of hospitalisation. Age, duration of diabetes, blood pressure, ALT, smoking status and edema are the influencing factors of hospitalisation times. The most common causes of hospitalisation for diabetics are poor glycemic control, infection, edema, dizziness, and weakness. Controlling these factors may be key to developing rational health strategies for rural diabetics.

scholarly journals Penetration of Piperacillin and Tazobactam into Inflamed Soft Tissue of Patients with Diabetic Foot Infection

2005 ◽  
Vol 49 (10) ◽  
pp. 4368-4371 ◽  
Author(s):  
F. J. Legat ◽  
R. Krause ◽  
P. Zenahlik ◽  
C. Hoffmann ◽  
S. Scholz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Extracellular Space ◽  
Soft Tissues ◽  
In Vivo Microdialysis ◽  
Diabetic Foot Infection

ABSTRACT We investigated the pharmacokinetics of piperacillin and tazobactam in the extracellular space fluid of inflamed soft tissues of six patients with diabetic foot infection using in vivo microdialysis and found similar penetration for piperacillin but not for tazobactam into inflamed and noninflamed soft tissue.

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