scholarly journals Multidisciplinary Approach for the Management and Treatment of Diabetic Foot Infections with a Resorbable, Gentamicin-Loaded Bone Graft Substitute

2020 ◽  
Vol 9 (11) ◽  
pp. 3586
Author(s):  
Christine Whisstock ◽  
Antonio Volpe ◽  
Sasa Ninkovic ◽  
Mariagrazia Marin ◽  
Marco Meloni ◽  
...  
Keyword(s):  
Bone Graft ◽  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
Calcium Sulphate ◽  
Bone Graft Substitute ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Adequate Treatment ◽  
Diabetic Foot Infections ◽  
Increased Risk

Diabetic patients are at increased risk of developing foot ulcers which may cause bone infections associated with a high probability of both amputation and mortality. Therefore, prompt diagnosis and adequate treatment are of key importance. In our Diabetic Foot Unit, effective multidisciplinary treatment of osteomyelitis secondary to diabetes involves the application of a gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute to fill residual bone voids after debridement. The data of all patients treated with the gentamicin-eluting calcium sulphate/hydroxyapatite bone graft substitute for diabetic foot infections with ulcer formation and osteomyelitis at metatarsals, calcaneus and hindfoot at our institute from July 2013 to September 2016 were retrospectively collected and evaluated. A total of 35 patients were included in this retrospective single-arm case series and were either continuously followed up for at least one year or until healing was confirmed. Nineteen lesions affected the distal row of tarsus/talus, ten the calcaneus and a further six were located at the metatarsals. While all of the metatarsal lesions had healed at 1-year follow-up, the healing rate in the hindfoot region was lower with 62.5% at the calcaneus and 72.2% at the distal tarsus and talus at 12 months, respectively. The overall cure rate for ulcerous bone infection was 81.3%. In two calcaneal lesions (25%) and two lesions of distal tarsus/talus (11.1%) amputation was considered clinically necessary. Promising results were achieved in the treatment of diabetic foot infections with soft tissue ulcers by a multidisciplinary approach involving extensive debridement followed by adequate dead space management with a resorbable gentamicin-eluting bone graft substitute.

Treatment of Diabetic Foot Infections

2020 ◽  
Author(s):  
Shimpo Aoki ◽  
Lauren R Bayer ◽  
Dennis P Orgill
Keyword(s):  
Diabetic Foot ◽  
Multidisciplinary Approach ◽  
New Technologies ◽  
Wound Care ◽  
Full Range ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Diabetic Foot Infections ◽  
Biomechanical Changes

Thirteen percent of diabetic patients will develop a foot ulcer, often associated with infection, vascular disease and biomechanical changes. Limb salvage offers the potential to restore function but does not correct the underlying metabolic disturbance. We review the surgical approach to diabetic foot infections including debridement, skin grafts, local flaps and a variety of new technologies. A comprehensive multidisciplinary approach is beneficial to optimize outcomes. The full range of reconstructive options available to plastic surgeons may be used in the treatment of diabetic foot ulcers. This review has 5 figures, 2 tables, and 20 references. Key words: Diabetic Foot Infection (DFI), Diabetic Foot Ulcer (DFU), Diabetes Mellitus (DM), wound care, foot infection, bacterial infection, surgical management, neuropathy, surgery of the lower extremity, deformities

scholarly journals Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328
Author(s):  
Pushpalatha Bangalore Lingegowda ◽  
Say-Tat Ooi ◽  
Jyoti Somani ◽  
Chelsea Law ◽  
Boon Kiak Yeo
Keyword(s):  
Infectious Diseases ◽  
Diabetic Foot ◽  
Wound Care ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Multidisciplinary Teams ◽  
Diabetic Patients ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

scholarly journals DIABETIC FOOT INFECTIONS;

2008 ◽  
Vol 15 (01) ◽  
pp. 153-161
Author(s):  
MUHAMMAD SAEED AKHTAR ◽  
MAQSOOD AHMAD ◽  
MUHAMMAD BADAR BASHIR ◽  
Muhammad Irfan ◽  
Zahid Yasin Hashmie
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Surgical Department ◽  
Diabetic Foot Infections ◽  
Group A ◽  
Hospital Stays ◽  
Male Patients ◽  
Group B

Objective: (1) To evaluate the effects of G-CSF in eliminating infection in diabetic foot wound (2) Tocompare the effects with conventional diabetic foot management. Design: Prospective, open, randomized comparativestudy. Setting: Medical&Surgical Department of Allied, DHQ Hospital & Nawaz Medicare Faisalabad. Period: FromJan 2000 to Nov 2000 Patients & Methods: Fifty diabetic patients with foot infections were included in this study. Themean age was 52 years ranging from 27 to 60 years. They were divided into two equal groups(Group A and Group B).Results: The male patients were 41(82%) and female 9(18%). Forty six percent of patients were on oral hypoglycaemicdrugs, and 54% on insulin. The trauma preceding infection was 20%, Peripheral neuropathy 94% and peripheralvascular disease 34%. Thirty two percent of patients were smoker. Group A were subjected to G-CSF ( Neupogen )therapy (n=25) subcutanously daily for 5days in addition to conventional measures. Whereas patients in Group Breceived only conventional therapy. Both groups received similar antibiotic and insulin treatment. G-CSF therapy wasassociated with earlier eradication of pathogens from the infected ulcer (median 5 [range 2-11] vs11 [6-31] days in thegroup B; (p=<O.000I), quicker resolution of cellulitis (6 vs l4 days; p<O.0001), shorter hospital stay (8 vsl6 days;p<O.000l), and a shorter duration of intravenous antibiotic treatment (7 vs l4 days ;p—0.0001).No G-CSF treatedpatient needed surgery, whereas three patients in group B underwent toe amputation and six had extensivedebridement under anaesthesia (p=0.00 1). G-CSF therapy was generally well tolerated. Conclusion: Granulocytecolony stimulating factor (G-CSF) may be used as a good adjuvant therapy along with conventional measures for themanagement of diabetic foot infection, as it promotes the healing of diabetic foot ulcer/cellulitis and consequentlyprevents many hazardous complications like amputation of limbs, long hospital stays, extensive and prolonged antibioticuse and last but not the least the total misery of the patients.

Comparison of acute kidney injury in patients prescribed vancomycin in combination with piperacillin–tazobactam or cefepime for diabetic foot infections

2021 ◽  
pp. jim-2020-001594
Author(s):  
Sarah R Piccuirro ◽  
Anthony M Casapao ◽  
Alyssa M Claudio ◽  
Carmen Isache ◽  
Christopher A Jankowski
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Foot ◽  
Group Versus ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Hospital Charges ◽  
Diabetic Patients ◽  
Concomitant Therapy ◽  
Total Hospital ◽  
Diabetic Foot Infections

Concomitant therapy with vancomycin (VAN) and piperacillin–tazobactam (PTZ) has been associated with acute kidney injury (AKI). Diabetic patients may be more susceptible to AKI due to various factors. In an observational, retrospective, cohort study of adults treated for diabetic foot infections (DFIs), rates of AKI were compared between groups receiving VAN+PTZ versus VAN+cefepime (CFP). Among 356 patients screened for inclusion, 210 were analyzed. Forty-nine of 140 patients (35%) in the VAN+PTZ group and 5 of 70 patients (7%) in the VAN+CFP group developed AKI according to the Acute Kidney Injury Network criteria (OR 7.00 (95% CI 2.64 to 18.53), p<0.001). After adjusting for baseline differences, VAN+PTZ was an independent predictor of AKI (OR 6.21 (95% CI 2.30 to 16.72), p<0.001). Time to AKI was 102.1 hours (IQR 47–152.7) in the VAN+PTZ group versus 78.3 hours (IQR 39.8–100.6) in the VAN+CFP group (p>0.999). Median length of stay was significantly higher in the VAN+PTZ group at 11.9 days (IQR 7.9–17.8) versus 7.8 days (IQR 4.9–12.1) in the VAN+CFP group (p<0.001). VAN+PTZ was also associated with higher total hospital charges at US$99,742.83 (IQR US$69,342.50–US$165,549.59) compared with US$74,260.25 (IQR US$48,446.88–US$107,396.99) in the VAN+CFP arm (p<0.001). In conclusion, VAN+CFP should be the preferred empiric regimen in patients with severe DFI.

Assessing Diabetic Foot Infections With the ThermoScale: A Comparative Thermometry Device Designed as a Patient Self-Screening Tool

2020 ◽  
pp. 153473462094830
Author(s):  
Laure Arts ◽  
Johan De Neve ◽  
Samira Baharlou ◽  
Nathalie Denecker ◽  
Laura Kerselaers ◽  
...  
Keyword(s):  
Temperature Measurement ◽  
Diabetic Foot ◽  
Characteristic Curve ◽  
Screening Method ◽  
Area Under The Curve ◽  
Control Group ◽  
Measurement Technology ◽  
Diabetic Patients ◽  
Home Setting ◽  
Diabetic Foot Infections

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet. Temperature differentials in DFI patients (n = 52) were compared with a control group of similar diabetic patients (n = 45) without any foot wounds. Based on these findings, we drafted a receiver operating characteristic curve to determine an area-under-the-curve of 0.8455. This value suggests that the ThermoScale, as a diagnostic test, is reasonably accurate. A cutoff value of 2.15 °C temperature difference corresponded with a sensitivity of 88.9% and a specificity of 61.5%. As wearables, portable health electronics, and telemedicine become increasingly popular, we think that comparative temperature measurement technology is valuable in improving early diagnosis of DFIs.

scholarly journals Factors Affecting the Outcomes of Tibiotalocalcaneal Fusion

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Charles C. Pitts ◽  
Bradley Alexander ◽  
Joshua L. Washington ◽  
Hannah M. Barranco ◽  
Romil K. Patel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Postoperative Complications ◽  
Kidney Disease ◽  
Bone Graft ◽  
Postoperative Infection ◽  
High Rate ◽  
Diabetic Patients ◽  
Charcot Arthropathy ◽  
Infection Rates ◽  
Increased Risk

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. Methods: We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. Results: Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). Conclusion: We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. This helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. [Table: see text]

The use of absorbable antibiotic-impregnated calcium sulphate pellets in the management of diabetic foot infections

2001 ◽  
Vol 18 (11) ◽  
pp. 942-943 ◽  
Author(s):  
D. G. Armstrong ◽  
A. H. Findlow ◽  
S. O. Oyibo ◽  
A. J. M. Boulton
Keyword(s):  
Diabetic Foot ◽  
Calcium Sulphate ◽  
Diabetic Foot Infections

scholarly journals Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers

2013 ◽  
Vol 7 (10) ◽  
pp. 707-712 ◽  
Author(s):  
Vedat Turhan ◽  
Mesut Mutluoglu ◽  
Ali Acar ◽  
Mustafa Hatipoglu ◽  
Yalcın Onem ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Geographical Location ◽  
Antibiotic Sensitivity ◽  
Diabetic Patients ◽  
Tissue Samples ◽  
Gram Negative ◽  
Diabetic Foot Infections ◽  
Pseudomonas Species ◽  
Gram Negative Organisms

Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles. Methodology: We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010. Results: We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial. Gram-negative bacterial isolates (n = 191; 61.3%) significantly outnumbered Gram-positive isolates (n = 121; 38.7%). The most frequently isolated bacteria were Pseudomonas species (29.8%), Staphylococcus aureus (16.7%), Enterococcus species (11.5%), Escherichia coli (7.1%), and Enterobacter species (7.1%), respectively. While 13.2% of the Gram-negative isolates were inducible beta-lactamase positive, 44.2% of Staphylococcus aureus isolates were methicillin resistant. Conclusions: Our results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.

scholarly journals Determination of Tissue Penetration and Pharmacokinetics of Linezolid in Patients with Diabetic Foot Infections UsingIn VivoMicrodialysis

2011 ◽  
Vol 55 (9) ◽  
pp. 4170-4175 ◽  
Author(s):  
Dora E. Wiskirchen ◽  
Ashley Shepard ◽  
Joseph L. Kuti ◽  
David P. Nicolau
Keyword(s):  
Protein Binding ◽  
Diabetic Foot ◽  
Terminal Phase ◽  
Diabetic Patients ◽  
Infected Wound ◽  
Tissue Penetration ◽  
Unbound Fraction ◽  
Content Type ◽  
Diabetic Foot Infections ◽  
Wound Tissue

ABSTRACTStaphylococcus aureusand other Gram-positive organisms, including methicillin-resistantS. aureus, continue to be the predominant pathogens associated with diabetic foot infections. Consequently, linezolid is often used to treat these infections. The purpose of the current study was to describe the pharmacokinetic profile and determine the level of penetration of linezolid into healthy thigh tissue and infected wound tissue of the same extremity in 9 diabetic patients with chronic lower limb infections by use ofin vivomicrodialysis. Hourly plasma and dialysate samples were obtained over a 12-h dosing interval following 3 to 4 doses of linezolid (600 mg intravenously every 12 h). Plasma protein binding was also assessed at 1, 6, and 12 h postdose. The means ± standard deviations (SD) for the maximum concentration in serum (Cmax), the volume of distribution at terminal phase (Vz), and the half-life (t1/2) for linezolid in plasma were 11.99 ± 3.67 μg/ml, 0.71 ± 0.25 liters/kg of body weight, and 4.71 ± 1.23 h, respectively. Mean protein binding was 14.78% (range, 3.85 to 32.03%). The mean areas under the concentration-time curves from 0 to 12 h for the free, unbound fraction of linezolid (fAUC0–12values) ± SD for plasma, wound tissue, and thigh tissue were 51.24 ± 12.72, 82.76 ± 59.01, and 92.52 ± 60.44 μg · h/ml, respectively. Tissue penetration ratios (tissuefAUC to plasmafAUC) were similar for thigh (1.42; range, 1.08 to 2.23) and wound (1.27; range, 0.86 to 2.26) tissues (P= 0.648). With the currently approved dosing regimen, linezolid penetrated well into both healthy thigh tissue and infected wound tissue in these diabetic patients.

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