The Economic Impact of Hospitalization for Diabetic Foot Infections in a Caribbean Nation

Cawich, Shamir O; Islam, Shariful; Subramanian, Hariharan; Harnarayan, Patrick; Budhooram, Steve; Ramsewak, Shivaa; Naraynsingh, Vijay

doi:10.7812/tpp/13-096

Cited by 37 publications

(48 citation statements)

References 21 publications

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“…Looking at the financial side, annual direct medical costs related for diabetes in the US alone were estimated at $176 billion in 2012 [11]. In a single hospital in Trinidad and Tobago, cost for the care of only 446 DFI patients was $14 million US dollars per year [12], which the authors extrapolated to represent 0.4% of the entire gross domestic product of that country. The direct antibiotic-related costs for a DFI may add up to US $1000 US dollars in Australia [13].…”

Section: Discussionmentioning

confidence: 99%

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Waibel¹,

Berli²,

Catanzaro³

et al. 2019

Preprint

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Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI.Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is "remission of infection" after a minimal follow-up of two months. The 1 st RCT allocates the amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The 2 nd RCT randomizes the conservative approach in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, internist and infectiology care.During the surgeries, we collect tissues for BioBanking and future laboratory studies.Discussion: Both parellel RCT will enable to prescribe less antibiotics for DFI; for a conservative therapy and after amputation. Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4 th September 2019. Protocol version : 2 (15 th July 2019) Study settingThe Balgrist University Hospital in Zurich is a tertiary referral center for DFI and amputations (emergency and elective consultations with a 24-hour service) and affiliated to the University of Zurich. Regarding DFIs, it resumes a multidisciplinary team composed of four diabetic foot surgeons, three internist physicians, a hospital pharmacist, five specialized wound nurses, musculoskeletal expert radiologists, a diabetes nurse, three nutritionists, a shoemaker, a prosthesis specialist, and up to four infectious diseases physicians who are specialized in orthopedic infections. Moreover, this team is supported by an in-house company for orthopedic footwear (Balgrist Tec) and individual adaptations of off-loading devices, a re-education unit, physical therapy, a research campus (Balgrist

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Section: Discussionmentioning

confidence: 99%

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Waibel¹,

Berli²,

Catanzaro³

et al. 2019

Preprint

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“…A literatura é clara ao descrever o comprometimento psicológico e financeiro de pacientes diabéticos com úlcera plantar (8) . Isso pode ser explicado pelo impacto socioeconômico causado pela doença devido: ao aumento do número e tempo de internações nessa população (5,6) , gastos com cuidadores, transporte, calçados e adaptações estruturais na moradia (6) .…”

Section: Discussionunclassified

“…Estima-se que 85% das amputações não traumáticas sejam precedidas de ulceração complicada com gangrena e infecções (3,4) . Além do comprometimento clínico decorrente das úlceras nos pés, o impacto econômico causado também deve ser considerado (5,6) . O tratamento eventualmente implica em internações e estas são 59% mais prolongadas em pacientes diabéticos com úlceras nos pés se comparados aos pacientes sem úlceras (1) .…”

Section: Introductionunclassified

Functional evaluation of diabetic patients with foot ulcers

et al. 2018

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Objective: The objective of this study was to perform a functional evaluation of diabetic patients with plantar ulcers using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: In this prospective cohort study, 50 diabetic patients treated in an outpatient clinic under conservative management were consecutively evaluated for active ulcers on the foot. The ulcer mean progression time, size and classification and the AOFAS score were evaluated. Results: Among the sample, 38 (76%) were men, the mean age was 64 years, and the mean body mass index was 28.27 kg/m2. The mean ulcer progression time was 9 months, and 40 (80%) patients were classified as Wagner grade 1. There was a significant difference in AOFAS scoresbetween ulcer grades. Conclusion: The AOFAS score can be used for functional evaluation in diabetic patients with ulcers. However, due to the peculiarities of this population, it is important to search for new and more comprehensive evaluation instruments. Level of Evidence II; Prognostic Studies; Prospective Study.

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“…Approximately 15% of the general adult population in Trinidad and Tobago has diabetes mellitus 1. These persons have 0.75% annual risk to develop lower limb infections 1.…”

Section: Discussionmentioning

confidence: 99%

Self-directed treatment for lower limb wounds in persons with diabetes: a short report

Harnarayan¹,

Cawich²,

Islam³

et al. 2014

PPA

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AimThere has been little focus on self-directed treatment for lower limb wounds, although it a common practice among persons with diabetes across the Caribbean. We sought to document this practice in a Caribbean nation.MethodsWe prospectively interviewed all consecutive patients with diabetes who were admitted with lower limb wounds at the San Fernando General Hospital in Trinidad and Tobago over a period of 18 months. A questionnaire was used to collect data on patient demographics, use of self-directed treatment, and details of these treatments.ResultsOf 839 persons with diabetes who were admitted with infected lower limb wounds, 344 (41%) admitted to self-directed treatment before seeking medical attention. These patients were predominantly male (59.9%) at a mean age of 56.4±12.4 years. The practice was most common in persons of Afro-Caribbean descent (45.9%) and those with type 2 diabetes (93.9%). In this group, 255 (74.4%) patients were previously admitted to hospital for lower limb infections. And of those, 32 (12.6%) had a prior amputation and 108 (42.4%) had at least one operative debridement specifically for foot infections.ConclusionCaribbean cultural practices may be an important contributor to negative outcomes when treating lower limb wounds in persons with diabetes. Despite being acutely aware of the potentially devastating consequences of inadequate treatment, 41% of our patients with diabetes still opted to use self-directed treatment for lower limb wounds. This deserves further study in order to give a more tailored approach in care delivery.

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The Economic Impact of Hospitalization for Diabetic Foot Infections in a Caribbean Nation

Cited by 37 publications

References 21 publications

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Functional evaluation of diabetic patients with foot ulcers

Self-directed treatment for lower limb wounds in persons with diabetes: a short report

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The Economic Impact of Hospitalization for Diabetic Foot Infections in a Caribbean Nation

Cited by 37 publications

References 21 publications

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Functional evaluation of diabetic patients with foot ulcers

Self-directed treatment for lower limb wounds in&nbsp;persons with diabetes: a short report

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Self-directed treatment for lower limb wounds in persons with diabetes: a short report