scholarly journals Utilisation of the 2019 IWGDF diabetic foot infection guidelines to benchmark practice and improve the delivery of care in persons with diabetic foot infections

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Matthew Malone ◽  
Adriaan Erasmus ◽  
Saskia Schwarzer ◽  
Namson S. Lau ◽  
Mehtab Ahmad ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Diabetic Foot ◽  
Clinical Performance ◽  
Improve Patient Care ◽  
Delivery Of Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
Bone Biopsies ◽  
Patients With Diabetes

Abstract Aims To utilise the 2019 International Working Group on the Diabetic Foot (IWGDF) - diabetic foot infection (DFI) guidelines as an audit tool for clinical practice in patients with diabetes attending a High-Risk Foot Service. Methods Data from 93 consecutive patients were collected over a 19-month period in patients attending a High-Risk Foot Service. The diagnosis and management of each patient in the sample were compared against the 2019 IWGDF DFI guidelines, grouped into four categories: Diagnosis, Microbiology, Treatment of soft tissue infection, and Surgical treatment and osteomyelitis. Deficits in performance were recorded using the recommendations as a benchmark standard. Results There were 109 DFI events. Nineteen (63%) of the recommendations were met, 7 (24%) were partially met, and four (13%) recommendations were not met. Fourteen of the sample had no documented requests for full blood counts. Tissue was obtained for culture in 32 (29%) of the sample. No percutaneous bone biopsies were performed. Only 13 (28%) patients had intraoperative bone specimens sent for culture and sensitivities, with no bone specimens sent for histopathology. Modification of antibiotic therapy following available culture results was low, occurring in 12 out of 63 possible occasions (19%). The duration of antibiotic regimens in PEDIS 2 infections and osteomyelitis was greater than that recommended. Conclusions Utilising the IWGDF DFI guidelines to benchmark clinical practice is a useful tool to identify gaps in clinical performance or service delivery and may help to improve patient care.

scholarly journals Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

2019 ◽  
Vol 38 (1) ◽  
pp. 12-17
Author(s):  
Farah Nobi ◽  
Syed Al Nahian ◽  
Afrin Sultana ◽  
Rokhsana Sarmin ◽  
Ayesha Rahman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Peripheral Vascular ◽  
Tertiary Care Centre ◽  
Term Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

scholarly journals How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Heather Young ◽  
Whitney Miller ◽  
Randy Burnham ◽  
Susan Heard ◽  
Chrystal Berg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Negative Results ◽  
Diabetic Foot Infections ◽  
Preoperative Antibiotics ◽  
The Impact ◽  
Culture Negative ◽  
Culture Yield

abstractThe impact of preoperative antibiotics on culture of diabetic foot infection samples has not been studied. We found that increasing exposure to preoperative antibiotics was associated with less frequent growth of streptococci and anaerobes and more culture-negative results. In contrast, the yield of Staphylococcus aureus and Gram-negative bacilli was unaffected.

Surgical Off-loading of the Diabetic Foot

2010 ◽  
Vol 100 (5) ◽  
pp. 369-384 ◽  
Author(s):  
Robert G. Frykberg ◽  
Nicholas J. Bevilacqua ◽  
Geoffrey Habershaw
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Diabetic Foot ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Foot Ulcers ◽  
Foot Surgery ◽  
Patients With Diabetes

Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers. (J Am Podiatr Med Assoc 100(5): 369–384, 2010)

scholarly journals 1309. The Impact of Clinical Practice Guideline Using Educational Intervention for Improvement of Diabetic Foot Infections Treatment Outcomes

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S400-S400
Author(s):  
Mullika Phangmuangdee ◽  
Oranich Navanukroh ◽  
Pornpan Koomanachai
Keyword(s):  
Clinical Practice ◽  
Educational Intervention ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Diabetic Foot ◽  
Unfavorable Outcome ◽  
Secondary Outcome ◽  
Diabetic Foot Infections ◽  
The Impact ◽  
Microbiological Data

Abstract Background Diabetic foot infections (DFIs) are important cause of lower-extremity amputation. The inappropriate empirical antimicrobial therapy for DFI was associated with amputation. We created the Clinical Practice Guideline (CPG) of empirical antimicrobial (ATB) therapy for in-patients with DFIs. The primary outcome of present study was to evaluate the intervention using educate and training the surgeons to adhere with CPG. The secondary outcome was the decreasing of unfavorable outcome (amputations). Methods A prospective study of CPG implementation for treatment in adult in-patients who had DFIs was conducted at surgical and orthopedics wards. The CPG was developed by the investigator team based on the data from our previous study (submitted to publish). CPG was presented monthly to train the orthopedic and vascular surgeons for 1 year. The empirical ATB regimens were prescribed by the responsible surgeon who was trained to use CPG. Demographics data, wound characteristics, microbiological data, ATB therapy, and clinical outcome were recorded. The appropriate empirical ATB treatment was determined by investigators weather CPG matched or microbiological matched. The adherence to CPG, the appropriate empirical ATB, and the unfavorable outcome were analyzed. All data were reported by descriptive and inferential statistics. Results A total of 85 DFIs patients were enrolled. The patients received the appropriate empirical ATB matched to CPG and matched to microbiological data, were 87% and 67%, respectively. The unfavorable outcome was 26% while previously was 72.4% (submitted to publish data) before CPG implementation. The independent factors associated with unfavorable outcomes were (1) an inappropriate ATB and (2) infections with drug-resistant pathogens (adjusted relative ratio; aRR 2.98; 95% CI: 1.36–6.55, P = 0.007 and aRR 1.90; 95% CI: 1.05–3.43, P = 0.034, respectively). Conclusion The current study demonstrated that mothly training of CPG resulting in the high adherence (87%) of CPG use and resulting in high rate of appropriate empirical ATB. Educational intervention insisted the responsible physician for administration the appropriate ATB with the improvement of unfavorable outcome in DFIs. Disclosures All authors: No reported disclosures.

scholarly journals Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening for Patients with a Diabetic Foot Infection

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Kari A. Mergenhagen ◽  
Michael Croix ◽  
Kaitlyn E. Starr ◽  
John A. Sellick ◽  
Alan J. Lesse
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
International Classification Of Diseases ◽  
Methicillin Resistant ◽  
Content Type ◽  
Diabetic Foot Infection ◽  
Entire Cohort ◽  
Diabetic Foot Infections ◽  
Medical Centers ◽  
Classification Of Diseases

ABSTRACT Treatment of suspected methicillin-resistant Staphylococcus aureus (MRSA) is a cornerstone of severe diabetic foot infections; however, antibiotics can be associated with toxicity. The objective of this study was to determine the negative predictive value (NPV) of MRSA nares screening in the determination of subsequent MRSA in patients with a diabetic foot infection. This was a retrospective cohort study across Veterans Affairs (VA) medical centers from 1 January 2007 to 1 January 2018. Data from patients with an International Classification of Diseases (ICD) code for a diabetic foot infection with MRSA nares screening, and subsequent cultures were evaluated for the presence of MRSA. NPVs were calculated for the entire cohort, as well as for a subgroup representing deep cultures. Additionally, the distribution of all pathogens isolated from diabetic foot infections was determined. A total of 8,163 episodes were included in the analysis for NPV. The NPV of MRSA nares screening for MRSA diabetic foot infection was 89.6%. For the deep cultures, the NPV was 89.2%. The NPV for cultures originating from the foot was 89.7%, and the NPV for those originating from the toe was 89.4%. There were 17,822 pathogens isolated from the diabetic foot cultures. MRSA was isolated in 7.5% of cultures, and methicillin-susceptible S. aureus was isolated in 24.8%. Enterococcus was identified in 14.7% of cultures, Proteus in 7.3%, and Pseudomonas in 6.8% of cultures. Given the high NPVs, the use of MRSA nares screening may be appropriate as a stewardship tool for deescalation and avoidance of empirical anti-MRSA therapy in patients who are not nasal carries of MRSA.

scholarly journals Vitamin D and Diabetic Foot

2021 ◽  
Author(s):  
Antony Macido
Keyword(s):  
Vitamin D ◽  
Diabetic Foot ◽  
Large Scale ◽  
Negative Relationship ◽  
Hydroxyvitamin D ◽  
Diabetic Foot Infections ◽  
Randomized Controlled Studies ◽  
Patients With Diabetes ◽  
The Status ◽  
25 Hydroxyvitamin D

Approximately 15% of patients with diabetes mellitus (DM) are prone to developing diabetic foot ulcers (DFU) in their lifetime. The term vitamin D status or 25-hydroxyvitamin D [25(OH)D] levels are used interchangeably to represent the status of vitamin D in individuals throughout this paper. Evidence suggests a relationship between 25(OH)D levels and DFU. However, very minimal data is available on the association between DFU and vitamin D deficiency. After a careful review of the literature, it was inferred that vitamin D could be associated with DFU and diabetic foot infections. Available evidence on vitamin D and DFU suggests a negative correlation between 25(OH)D levels and the presence of DFU. Evidence also supports a negative relationship between 25(OH)D levels and diabetic foot infections. Further large-scale randomized controlled studies need to be done to confirm the relationship between 25(OH)D levels and DFU including the use of vitamin D in the management of DFU and diabetic foot infections.

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.

Foot infections in patients with diabetes mellitus

1989 ◽  
Vol 79 (10) ◽  
pp. 482-485 ◽  
Author(s):  
FL Sapico
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Patient ◽  
Diabetic Foot ◽  
Anaerobic Bacteria ◽  
Severe Infection ◽  
Host Factors ◽  
Antibiotic Selection ◽  
Diabetic Foot Infection ◽  
Predominant Type ◽  
Patients With Diabetes

Foot infection is the single most common reason for hospitalization of the diabetic patient. A combination of host factors, including neuropathy, angiopathy, and immunopathy, combine to make the diabetic foot infection the most severe infection commonly seen by podiatrists. If inadequately treated, the likelihood of morbidity or mortality is high. The presence of anaerobic bacteria as a predominant type of organism makes diagnosis and antibiotic selection complicated.

Surgical Diabetic Foot Infections: Is Osteomyelitis Associated With a Worse Prognosis?

2021 ◽  
pp. 153473462098669
Author(s):  
Javier Aragón-Sánchez ◽  
Gerardo Víquez-Molina ◽  
María Eugenia López-Valverde ◽  
José María Rojas-Bonilla ◽  
Christian Murillo-Vargas
Keyword(s):  
Hospital Stay ◽  
Antibiotic Treatment ◽  
Diabetic Foot ◽  
Length Of Hospital Stay ◽  
Limb Loss ◽  
Diabetic Foot Infections ◽  
Patients With Diabetes ◽  
Hospital Stays ◽  
Hospital Stay Duration ◽  
Worse Prognosis

It has been reported that patients with diabetes and foot ulcers complicated with osteomyelitis (OM) have a worse prognosis than those complicated with soft tissue infections (STI). Our study aimed to determine whether OM is associated with a worse prognosis in cases of moderate and severe diabetic foot infections requiring surgery. A retrospective series consisted of 150 patients who underwent surgery for diabetic foot infections. We studied the differences between OM versus STI. Furthermore, diabetic foot infections were reclassified into four groups: moderate STI (M-STI), moderate OM (M-OM), severe STI (S-STI), and severe OM (S-OM). The variables associated with prognosis were limb loss, length of hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing (both the initial ulcer and the postoperative wound). No differences in limb salvage, hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing were found when comparing OM with STI. Patients with M-O had a higher rate of recurrences after initial treatment and a longer time to healing when comparing with M-STI. We didn’t find any differences between severe infections with or without OM. In conclusion, we have found in our surgical series of diabetic foot infections that OM is not associated with worse prognosis when comparing with STI regarding limb loss rate, length of hospital stays, duration of antibiotic treatment, recurrence of the infection, and time to healing. The results of the present series should further be confirmed by other authors.

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