The impact of the length of total and intravenous systemic antibiotic therapy for the remission of diabetic foot infections

Haug, Florian; Waibel, Felix W A; Lisy, Marcus; Winkler, Elin; Uçkay, İlker; Schöni, Madlaina

doi:10.1016/j.ijid.2022.03.049

Cited by 13 publications

(24 citation statements)

References 44 publications

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“…Most below-knee amputations are predominantly necessitated by the presence of peripheral arterial disease related ischemia, whereas toe amputations are more often necessitated by factors such as destructive bone lesions, hammer toe deformities, and the presence of refractory DFUs, which can be further complicated by acute ischemia [ 1 , 2 , 3 , 4 , 5 , 6 ]. While appropriately administered medical and surgical therapy can often cure DFIs, clinical failures during or after treatment can be as high as 25%, even in specialized centers in resource-rich settings [ 5 , 6 , 7 ]. Reasons for these clinical failures are often complex and may be caused by the presence of multiple and simultaneous clinical entities [ 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among these, foot ischemia usually plays the predominant role. Among all clinical failures, only 5–15% are true infection recurrences, which have previously been called the microbiological failure [ 5 , 6 ]. This is a subset of clinical failure in which the majority of the causative pathogens in the recurrence are identical to those of the prior infection [ 5 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among all clinical failures, only 5–15% are true infection recurrences, which have previously been called the microbiological failure [ 5 , 6 ]. This is a subset of clinical failure in which the majority of the causative pathogens in the recurrence are identical to those of the prior infection [ 5 , 7 ]. This relatively infrequent type of infectious recurrence is most often attributed to poor patient compliance or clinicians selecting the wrong empirical antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

“…The occurrence of infection is most often the ultimate and limb-threatening complication of chronic underlying ischemic or neuropathic problems that have remained unresolved. DFIs can be devastating, especially amputations, but also lead to prolonged hospital stays, long-duration antibiotic therapy [ 5 ], and adverse events related to therapies [ 5 , 6 ]. In several prospective trials, antibiotic-related adverse events occurred in 10–15% per DFI episode [ 5 , 6 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Timing of Revascularization and Parenteral Antibiotic Treatment Associated with Therapeutic Failures in Ischemic Diabetic Foot Infections

et al. 2023

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For ischemic diabetic foot infections (DFIs), revascularization ideally occurs before surgery, while a parenteral antibiotic treatment could be more efficacious than oral agents. In our tertiary center, we investigated the effects of the sequence between revascularization and surgery (emphasizing the perioperative period of 2 weeks before and after surgery), and the influence of administering parenteral antibiotic therapy on the outcomes of DFIs. Among 838 ischemic DFIs with moderate-to-severe symptomatic peripheral arterial disease, we revascularized 608 (72%; 562 angioplasties, 62 vascular surgeries) and surgically debrided all. The median length of postsurgical antibiotic therapy was 21 days (given parenterally for the initial 7 days). The median time delay between revascularization and debridement surgery was 7 days. During the long-term follow-up, treatment failed and required reoperation in 182 DFI episodes (30%). By multivariate Cox regression analyses, neither a delay between surgery and angioplasty (hazard ratio 1.0, 95% confidence interval 1.0–1.0), nor the postsurgical sequence of angioplasty (HR 0.9, 95% CI 0.5–1.8), nor long-duration parenteral antibiotic therapy (HR 1.0, 95% CI 0.9–1.1) prevented failures. Our results might indicate the feasibility of a more practical approach to ischemic DFIs in terms of timing of vascularization and more oral antibiotic use.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Timing of Revascularization and Parenteral Antibiotic Treatment Associated with Therapeutic Failures in Ischemic Diabetic Foot Infections

et al. 2023

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“…In the diabetic population, DFU is a common longterm complication with high morbidity and, in several cases, may lead to mortality. DFU is subjected to frequent infections in deep tissues leading to damage to the dermis and epidermis (Haug et al, 2022). DFU is also characterized by a prolonged inflammation phase, inadequate cytokines and growth factors, and impaired proliferation and migration of skin fibroblasts and keratinocytes (Falanga, 2005;Galkowska et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Engineering diabetic human skin equivalent for in vitro and in vivo applications

Abedin-Do

Zhang

Douville

et al. 2022

Front. Bioeng. Biotechnol.

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The prevalence of diabetes is increasing worldwide. Diabetes contributes to 70% of all non-traumatic lower-limb amputations, which are directly caused by diabetic foot ulcers (DFU) that are difficult to heal. Non-healing diabetic ulcers represent one of modern society’s most difficult medical challenges. One of the promising initiatives to treat DFU is the grafting of autologous skin or stimulating the skin cells at the edge of the wound to proliferate and close the wound. The present study was to engineer a diabetic human skin equivalent (DHSE) that contains fibroblasts and keratinocytes extracted from the skin collected from diabetic patients. The DHSE was used to investigate whether exposure to low-intensity electrical stimulation (ES) could promote diabetic cell activity. The ES was generated by a direct current (DC) electric field of 20 or 40 mV/mm. We demonstrated that the fibroblasts and keratinocytes could be extracted from older diabetics, cultured, and used to engineer DHSE. Interestingly, the exposure of DHSE to ES led to a structural improvement through tissue stratification, increased Ki-67 expression, and the deposition of basement membrane proteins (laminin and type IV collagen). The DHSE exposed to ES showed a high level of keratin 5 and 14 expressions in the basal and supra-basal layers. The keratinocyte proliferation was supported by an increased secretion of the keratinocyte growth factor (FGF-7). Exposure to ES decreased the activity of metalloproteinases (MMP) 2 and 9. In conclusion, we extracted keratinocytes and fibroblasts from the skin of diabetic-old donors. These cells were used to engineer skin equivalents and demonstrate that ES can promote diabetic wound healing. This DHSE can be a promising tool for various in vitro studies to understand the wound healing mechanisms under chronic inflammatory conditions such as diabetes. The DHSE could also be used as an autologous substrate to cover the DFU permanently.

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IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

Senneville,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the management and prevention of diabetes‐related foot diseases since 1999. The present guideline is an update of the 2019 IWGDF guideline on the diagnosis and management of foot infections in persons with diabetes mellitus.The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used for the development of this guideline. This was structured around identifying clinically relevant questions in the P(A)ICO format, determining patient‐important outcomes, systematically reviewing the evidence, assessing the certainty of the evidence, and finally moving from evidence to the recommendation. This guideline was developed for healthcare professionals involved in diabetes‐related foot care to inform clinical care around patient‐important outcomes. Two systematic reviews from 2019 were updated to inform this guideline, and a total of 149 studies (62 new) meeting inclusion criteria were identified from the updated search and incorporated in this guideline. Updated recommendations are derived from these systematic reviews, and best practice statements made where evidence was not available. Evidence was weighed in light of benefits and harms to arrive at a recommendation. The certainty of the evidence for some recommendations was modified in this update with a more refined application of the GRADE framework centred around patient important outcomes. This is highlighted in the rationale section of this update. A note is also made where the newly identified evidence did not alter the strength or certainty of evidence for previous recommendations.The recommendations presented here continue to cover various aspects of diagnosing soft tissue and bone infections, including the classification scheme for diagnosing infection and its severity. Guidance on how to collect microbiological samples, and how to process them to identify causative pathogens, is also outlined. Finally, we present the approach to treating foot infections in persons with diabetes, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and bone infections; when and how to approach surgical treatment; and which adjunctive treatments may or may not affect the infectious outcomes of diabetes‐related foot problems.We believe that following these recommendations will help healthcare professionals provide better care for persons with diabetes and foot infections, prevent the number of foot and limb amputations, and reduce the patient and healthcare burden of diabetes‐related foot disease.

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The impact of the length of total and intravenous systemic antibiotic therapy for the remission of diabetic foot infections

Cited by 13 publications

References 44 publications

Timing of Revascularization and Parenteral Antibiotic Treatment Associated with Therapeutic Failures in Ischemic Diabetic Foot Infections

Timing of Revascularization and Parenteral Antibiotic Treatment Associated with Therapeutic Failures in Ischemic Diabetic Foot Infections

Engineering diabetic human skin equivalent for in vitro and in vivo applications

IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes‐related foot infections (IWGDF/IDSA 2023)

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