scholarly journals Non-surgical therapy of diabetic foot infections based on recent guidelines and published data

2020 ◽  
Vol 93 (2) ◽  
pp. 53-62
Author(s):  
Urbán Edit ◽  
Gajdács Márió
Keyword(s):  
Surgical Therapy ◽  
Diabetic Foot ◽  
Eating Habits ◽  
Published Data ◽  
Diabetic Foot Infections ◽  
Increasing Trend ◽  
Onset Of Diabetes ◽  
Diabetic Foot Osteomyelitis

Abstract Chronic, non-communicable diseases are affecting the lives of more and more people worldwide; due to obesity and inadequate eating habits, the proportion of diabetics is on an increasing trend globally. The development of a number of macro- and microangiopathic pathologies associated with the onset of diabetes affects the life expectancy of patients. Diabetic foot infection (DFI) is one of the most serious long-term complications of diabetes and may be considered an intersection of infectious and non-infectious diseases; these infections can significantly reduce the quality of life of affected patients. The purpose of this review was to summarize the latest recommendations for conservative (non-surgical) therapy for DFIs and diabetic foot osteomyelitis (DFO).

Comparison of Collagen Granule Dressing Versus Conventional Dressing in Patients With Diabetic Foot Ulcer

2020 ◽  
pp. 153473462093898
Author(s):  
Bayram Colak ◽  
Serdar Yormaz ◽  
Ilhan Ece ◽  
Akin Çalişir ◽  
Kazım Körez ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Duration Of Treatment ◽  
Collagen Group ◽  
Physiological Serum ◽  
Better Than

Background. Diabetic foot ulcer (DFU) is a difficult, chronic wound with a significant long-term influence on the morbidity, mortality, and quality of life of patients. There is much information about the biochemical features of collagen and its function in wound healing. The aim of this study was to compare the results of DFU patients treated with and without collagen. Methods. A retrospective evaluation was made of the data of patients with DFU who underwent collagen treatment and physiological serum (PS) treatment. The patients were followed-up for a minimum of 12 weeks, and all complications, healing process, and wound characteristics were recorded. Results. Of the total 64 DFU patients included in the study, 30 were treated with PS and 34 with collagen. Complete closure was achieved in 17 (56.6%) of the PS group patients after 12 weeks of treatment. The rate was 25 (73.5%) in the collagen group. The mean duration of treatment was 9.2 weeks (range = 6-12 weeks) in the PS group and 8.08 weeks (range = 5-12 weeks) in the collagen group. The recovery time and recovery rates were determined to be better in the collagen group than in the PS group. Conclusion. A significant reduction in wound size was seen in the collagen group compared with the PS group. The results of this study demonstrated that collagen dressings are better than conventional dressings with regard to early granulation tissue and shorter hospital stay.

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

scholarly journals Assessment of the outcomes of the treatment of patients with suppurative necrotic complications of diabetic foot syndrome with the use of programmed rehabilitation technologies

2018 ◽  
Vol 177 (6) ◽  
pp. 63-68 ◽  
Author(s):  
A. A. Glukhov ◽  
V. V. Sergeev ◽  
G. A. Semyonova
Keyword(s):  
Diabetic Foot ◽  
Reference Group ◽  
Postoperative Mortality ◽  
Diabetic Foot Syndrome ◽  
Study Group ◽  
Long Term Outcomes ◽  
Short Term ◽  
Critical Ischemia

Objective.To assess the outcomes of the treatment of patients with suppurative necrotic complications of diabetic foot syndrome (DFS) without critical ischemia with the use of programmed rehabilitation technologies (PRT).Materialand methods.The study included 82 patients. 40 patients (reference group) underwent conventional rehabilitation, while 42 patients (study group) were treated with PRT with the use of the original equipment AMP-01.Results.Use of PRT has been established to significantly improve the quality of rehabilitation, which helps to reduce the duration of inpatient treatment. The number of suppurative complications in the study group proved to be significantly less (p=0.014), and postoperative mortality was lower. The long-term outcomes of the treatment (number of late suppurative complications, ischemia progression, maintenance of foot support ability) in the study group was also found to be significantly better compared to the reference group.Conclusion.The use of PST promotes the improvement of short-term and long-term outcomes of the treatment of the patients with DFS suppurative necrotic complications.

scholarly journals Long-Term Complications after Surgical or Medical Treatment of Predominantly Forefoot Diabetic Foot Osteomyelitis: 1 Year Follow Up

2021 ◽  
Vol 10 (9) ◽  
pp. 1943
Author(s):  
Aroa Tardáguila-García ◽  
Yolanda García-Álvarez ◽  
Esther García-Morales ◽  
Mateo López-Moral ◽  
Irene Sanz-Corbalán ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Diabetic Foot ◽  
Prospective Observational Study ◽  
Group Versus ◽  
Medical Group ◽  
Long Term Follow Up ◽  
Surgical Group ◽  
Diabetic Foot Osteomyelitis

Aim: To compare long-term complications according to the treatment received for management of diabetic foot osteomyelitis (surgical or medical) at 1 year follow up. Design and Participants: A prospective observational study was conducted involving 116 patients with diabetic foot osteomyelitis. The patients received surgical or medical treatment based on the principles described in the literature. To register the development of a complication, both groups of treatments were followed-up 1 year after the ulcer had healed. Results: Ninety-six (82.8%) patients received surgical treatment and 20 (17.2%) medical treatment. No differences were found in the time to healing between both groups of treatment, 15.7 ± 9.2 weeks in the surgical group versus 16.4 ± 12.1 weeks in the medical group; p = 0.103. During follow up, 85 (73.3%) patients developed complications without differences between both groups, 68 (70.8%) in the surgical group versus 17 (85%) in the medical group (p = 0.193). The most common complication in both groups was re-ulceration. We did not observe significant differences comparing complication-free time survival between both treatments (p = 0.665). Conclusion: The onset of complications after healing in patients who suffered from diabetic foot osteomyelitis was not associated with the treatment received. Surgical and medical approaches to the management of diabetic foot osteomyelitis produced similar results in long-term follow up.

scholarly journals Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective

2021 ◽  
Vol 10 (24) ◽  
pp. 5856
Author(s):  
Julie M. Marchant ◽  
Anne L. Cook ◽  
Jack Roberts ◽  
Stephanie T. Yerkovich ◽  
Vikas Goyal ◽  
...  
Keyword(s):  
Burden Of Illness ◽  
Disease Process ◽  
Parental Knowledge ◽  
Published Data ◽  
Long Term Effects ◽  
Respiratory Condition ◽  
Doctor Visits ◽  
Radiological Abnormality

Bronchiectasis is a neglected chronic respiratory condition. In children optimal appropriate management can halt the disease process, and in some cases reverse the radiological abnormality. This requires many facets, including parental/carer bronchiectasis-specific knowledge, for which there is currently no such published data. Further, the importance of patient voices in guiding clinical research is becoming increasingly appreciated. To address these issues, we aimed to describe the voices of parents of children with bronchiectasis relating to (a) burden of illness and quality of life (QoL), (b) their major worries/concerns and (c) understanding/management of exacerbations. The parents of 152 children with bronchiectasis (median age = 5.8 years, range 3.5–8.4) recruited from the Queensland Children’s Hospital (Australia) completed questionnaires, including a parent-proxy cough-specific QoL. We found that parents of children with bronchiectasis had impaired QoL (median 4.38, range 3.13–5.63) and a high disease burden with median 7.0 (range 4.0–10.0) doctor visits in 12-months. Parental knowledge varied with only 41% understanding appropriate management of an exacerbation. The highest worry/concern expressed were long-term effects (n = 42, 29.8%) and perceived declining health (n = 36, 25.5%). Our study has highlighted the need for improved education, high parental burden and areas of concern/worry which may inform development of a bronchiectasis-specific paediatric QoL tool.

scholarly journals 320. Does Guideline-Based Management of Diabetic Foot Osteomyelitis Reduce Risk of Further Proximal Amputations?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S232-S232
Author(s):  
Eugene Lee ◽  
Jakrapun Pupaibool ◽  
Laura Certain
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Primary Outcome ◽  
Adherence To Guidelines ◽  
Diabetic Foot Infections ◽  
Significant Difference ◽  
Antibiotic Management ◽  
Reduce Risk ◽  
Reduced Risk ◽  
Diabetic Foot Osteomyelitis

Abstract Background The antibiotic management of diabetic foot osteomyelitis involving surgical limb-sparing amputation is controversial. While there are several guidelines that provide recommendations regarding antibiotic therapy for diabetic foot osteomyelitis after amputation, we do not know of any studies that show that adherence to guidelines improves clinical outcomes. We assessed whether adherence to antibiotic choice and duration in accordance with our institution’s guidelines, which are based on IDSA guidelines, reduced risk of future amputations. Methods We conducted a retrospective cohort study of 110 patients with diabetic foot osteomyelitis treated with limb-sparing amputations at a VA hospital. We collected relevant clinical data such as patient comorbidities, antibiotic allergies, labs, imaging, culture data, histopathologic reports, pre-op and post-op antibiotics. We used our institutional guidelines, which are based on the 2012 IDSA Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections, to assess antibiotic choice and duration for diabetic foot osteomyelitis therapy after amputation. We stratified cases as either adherent or non-adherent based on whether antibiotic choice and duration were both in accordance with our institutional guideline. For each case, we recorded the primary outcome of further proximal amputation occurring within six months or death from all causes within three months. Results We found a significant difference in primary outcomes between the groups that were treated with antibiotics adherent with guidelines and antibiotics non-adherent with guidelines. For patients who were treated with antibiotics that were non-adherent to guidelines, 15 of 36 (42%) patients needed further amputation or died. Of the patients treated according to guidelines, 12 of 74 (16%) patients needed further amputation or died. There was a statistically significant difference between these two groups (p=0.004). Conclusion Our study showed that guideline-based antibiotic therapy for diabetic foot osteomyelitis treated with amputation significantly lowered rates of further amputation compared to antibiotic therapies that were not adherent to guidelines. Disclosures All Authors: No reported disclosures

scholarly journals The Association between Foot Surgery Type and Subsequent Healing in Veterans with Moderate-to-Severe Diabetic Foot Infections

2021 ◽  
Author(s):  
Justin J Kim ◽  
Alyson J Littman ◽  
John D Sorkin ◽  
Mary-Claire Roghmann
Keyword(s):  
Diabetic Foot ◽  
Common Knowledge ◽  
Foot Surgery ◽  
Bone Resection ◽  
Diabetic Foot Infections ◽  
Common Precursor ◽  
Confounding Variables ◽  
Binomial Regression ◽  
Transmetatarsal Amputation

Abstract Background Diabetic foot infections are a common precursor to lower extremity amputations. The treatment of diabetic foot infections involves both medical and surgical management, of which limb-sparing surgeries are increasingly preferred over amputations at or above the ankle to preserve mobility and quality of life. The outcomes following these limb-sparing surgeries are not well-described. Methods This was a single-center, retrospective cohort study of 90 Veterans with moderate-to-severe diabetic foot infections between 2017 and 2019 from the VA Maryland Health Care System. The exposure was foot surgery with bone resection (i.e., toe amputation, metatarsal resection, transmetatarsal amputation) versus debridement alone. The outcome was healing within 1 year. We used log-binomial regression to assess the association between foot surgery type and healing, stratify by infection location, and evaluate potential confounding variables. Results The cumulative incidence of healing after foot surgery with bone resection was greater than that following debridement (risk ratio 1.80, 95% confidence interval [1.17, 2.77]). This association was modified by infection location and greater for toe infections (4.52 [1.30, 15.7]) than other foot infections (1.19 [0.69, 2.02]). We found no evidence of confounding by comorbidities or infection severity. Conclusions For patients with toe infections, foot surgery with bone resection was associated with better healing than debridement alone. The multiple specialties caring for patients with diabetic foot infections need a stronger common knowledge base—from studies like this and future studies—to better counsel patients about their treatment and prognosis.

scholarly journals Manuscript title: The microbiology of diabetic foot infections: a single-center retrospective study and literature review

2021 ◽  
Vol 97 (1) ◽  
pp. 11-20
Author(s):  
Márió Gajdács ◽  
◽  
Gabriella Terhes ◽  
Marianna Ábrók ◽  
Andrea Lázár ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Late Onset ◽  
Infectious Complications ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Diabetic Foot Infections ◽  
Treatment Of Infection ◽  
Careful Management ◽  
Microbiological Procedures

Late-onset complications may cause serious problems in diabetic patients. Among these complications, diabetic foot infections play a signifcant role. In the recognition and management of the disease the microbiological procedures are essential. Neglected infectious complications may lead to gangrene, limb amputation, which not only impairs quality of life but also endangers the patient’s life. Prevention should include careful management of metabolic disease, appropriate medication, early detection of neuropathy, and the detection and treatment of infection by a medical team , including clinical microbiologist. In our present study, we retrospectively assessed the bacteriological culture’ results of patients with “diabetic foot” syndrome in 5-years’ clinical material at he Faculty of Medicine, University of Szeged.

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