Re-organizing inpatient care saves legs in patients with diabetic foot infections

Laakso, Miska; Honkasalo, Mikael; Kiiski, Juha; Ala‐Houhala, Marja; Haapasalo, Heidi; Laine, Heikki-Jussi; Luukkaala, Tiina; Lahtela, Jorma; Kaartinen, Ilkka

doi:10.1016/j.diabres.2017.01.007

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…Some studies have found that nerve defect wound is a risk factor for MDROs infection, which is consistent with the results of this survey ( Laakso et al, 2017 ; Datta et al, 2019 ; Lazaro-Martinez et al, 2022 ). Amin et al found that DFU patients with nerve ischemic wounds had a seven-fold increased risk of MDROs infection ( Amin & Doupis, 2016 ).…”

Section: Discussionsupporting

confidence: 93%

Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis

Guo,

Song,

Mei

et al. 2023

PeerJ

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Objective To investigate the distribution, drug resistance and risk factors of multi-drug resistant bacterias (MDROs) in patients with Type 2 diabetic foot ulcers (DFU). Method The clinical data, foot secretions, pathogenic microorganisms and drug sensitivity tests of 147 patients with type 2 diabetes admitted to our department from January 2018 to December 2021 were analyzed. Patients were divided into two groups according to whether they had been infected with MDROs or not. Seventy-one cases were infected with MDROs as the case group, and the remaining 76 cases were the control group. Chi-square test and t-test were used to analyze the results of MDROs infection and DFU, and logistic multivariate regression was used to evaluate the risk factors of MDROs infection. Results A total of 71 strains were isolated from the MDROs-positive group, with the top three being Staphylococcus aureus (46.48%), Escherichia coli (22.53%), and Pseudomonas aeruginosa (18.31%), respectively. Logistic multifactorial regression analysis showed that history of previous antimicrobial exposure, neuroischemic wound, Wagner grade 3–5, and combined osteomyelitis were associated with Type 2 diabetic foot infection MDROs (P < 0.05). Conclusion Previous history of antimicrobial exposure, neuroischemic wounds, Wagner grade 3–5, and combined osteomyelitis are independent risk factors for MDROs, which can identify the risk factors for MDROs at an early stage and help to identify people at high risk of MDROs infection and take relevant comprehensive treatment in time to slow down the development of the disease.

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Section: Discussionsupporting

confidence: 93%

Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis

Guo,

Song,

Mei

et al. 2023

PeerJ

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“…675 In a subsequent study, researchers reported a reduction in amputations and length of stay when inpatient care was reorganized. 676 Summary. Centers of Excellence can be implemented with a well-organized team approach to diabetic foot syndrome and, in particular, the foot with CLI.…”

Section: Creating a Center Of Excellence For Amputation Preventionmentioning

confidence: 99%

Global vascular guidelines on the management of chronic limb-threatening ischemia

Conte

Bradbury

Kolh³

et al. 2019

Journal of Vascular Surgery

1,067

865

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Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

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“…Based on our results, we propose that it is possible to arrange an optimal treatment pathway within a primary care setting, where a holistic wound care process is initiated, provided that there is organisational support, knowledge, skills and a multidisciplinary team available. It has been demonstrated that such an approach does not even require any additional resources, but rather a rearrangement of the patient care 16 42. We also suggest that the specialist care clinics could play a supportive role in the treatment of complex wounds, while the primary care system could take responsibility for the holistic wound care.…”

Section: Discussionmentioning

confidence: 85%

“…It has been demonstrated that such an approach does not even require any additional resources, but rather a rearrangement of the patient care. 16 42 We also suggest that the specialist care clinics could play a supportive role in the treatment of complex wounds, while the primary care system could take responsibility for the holistic wound care.…”

Section: Discussionmentioning

confidence: 97%

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Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting

2022

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ObjectivesExact wound diagnosis is essential for successful wound management and a holistic care of the patient suffering from a wound. Wound management has been traditionally seen as a nursing area, but this can lead to considerable delays in wound diagnostics. A diagnostic delay has been recognised as an element of diagnostic error, which, in turn, affects patient safety. The aim of this cohort study was to examine diagnostic delays of chronic wound within primary care.SettingA specialised diagnostic unit, a wound care team, was established in the primary healthcare with the objective of reducing diagnostic and treatment delays in primary care.ParticipantsThe data consists of 197 consecutive patients attending their first appointment with the wound care team in 2016. The collected data included basic demographics, information about the clinical pathway, including doctor’s appointments in primary and specialised care, as well as the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes.Primary and secondary outcome measuresThe diagnostic delays were calculated in days and divided into three groups: (1) patient-related delay, (2) diagnostic delay and (3) organisational delay.ResultsThe median duration of a patient-related delay was 2 days (IQR 0–14), whereas a physician’s first evaluation was performed at a median of 8 (1–32) days from wound appearance and the correct diagnosis by the wound care team was established in a median of 57 (33–100) days. The organisational delay from first contact to diagnosis was a median of 41 (22–80) days. Only one in three patients had a diagnostic delay of less than 4 weeks.ConclusionsAccording to this study, the diagnostic delay occurs within primary care, as an organisational delay from first contact to correct diagnosis. It is possible to arrange an optimal pathway of care in which a holistic wound care process starts within primary care.

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Re-organizing inpatient care saves legs in patients with diabetic foot infections

Cited by 11 publications

References 21 publications

Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis

Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis

Global vascular guidelines on the management of chronic limb-threatening ischemia

Cohort study of diagnostic delay in the clinical pathway of patients with chronic wounds in the primary care setting

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