Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians

Abstract

BackgroundDiabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand.MethodsA cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians’ management practices of patients with DFIs.ResultsApproximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely.ConclusionsPatients with DFIs represent a significant proportion of an ID clinician’s caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.Electronic supplementary materialThe online version of this article (10.1186/s13047-018-0256-3) contains supplementary material, which is available to authorized users.

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

“…Fortunately, almost all patents with a mild infection, and many with a moderate infection, can be treated in an ambulatory setting. Most published studies of DFIs have enrolled hospitalized patients, but over the past two decades, several have reported good results with outpatient treatment . The IDSA/IWGDF classification scheme was not designed to help determine when an infection has resolved (ie, the absence of signs and symptoms that were used to diagnose infection), but it makes sense that it could be used this way and has been in some studies of antibiotic therapy for DFIs.…”

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

“…Over one-third of people with diabetes develop diabetic foot ulcers (DFUs) during their lifetime, half of these becoming infected and causing diabetic foot infections. Fifteen percent of patients with DFUs require lower limb amputations to prevent the progression of the infection [1,3], highlighting the importance of early diagnosis and treatment of this pathology [4]. Patients with DFU are two to three times more likely to die than patients without DFU [5,6].…”

Bacterial Diversity of Diabetic Foot Ulcers: Current Status and Future Prospectives

“…More than one-third of people with diabetes develop diabetic foot ulcers (DFUs) during their lifetime, with half of these becoming infected and causing diabetic foot infections (DFIs). Fifteen percent of patients with DFIs require lower limb amputation to prevent progression of the infection [1,2].…”