Real time presence of a microbiologist in a multidisciplinary diabetes foot clinic

Paisley, Angela; Kalavalapalli, Shyam; Subudhi, Chinari; Chadwick, Paul; Chadwick, Paul; Young, Bob

doi:10.1016/j.diabres.2011.11.024

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…An additional large, welldesigned prospective study could largely answer the question. 6. Is there a definition and practical clinical use for the concept of wound 'bacterial bioburden'?…”

Section: How Should We Adapt Approaches To Dfi Management In Low-incomentioning

confidence: 99%

“…Managing infection requires careful attention to properly diagnosing the condition, obtaining appropriate specimens for culture, thoughtfully selecting empirical and then definitive antimicrobial therapy, quickly determining when surgical interventions are needed and providing all other necessary types of wound care. For these reasons, interdisciplinary teams should, whenever possible, include an infectious diseases or clinical microbiology specialist . A systematic and, to the extent possible, evidence‐based approach to diabetic foot infections (DFIs) should result in better outcomes.…”

Section: Introductionmentioning

confidence: 99%

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IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

495

561

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Recommendations Classification/diagnosis Diabetic foot infection must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong; low). Assess the severity of any diabetic foot infection using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme (strong; moderate). Osteomyelitis For an infected open wound, perform a probe‐to‐bone test; in a patient at low risk for osteomyelitis, a negative test largely rules out the diagnosis, while in a high‐risk patient, a positive test is largely diagnostic (strong; high). Markedly elevated serum inflammatory markers, especially erythrocyte sedimentation rate, are suggestive of osteomyelitis in suspected cases (weak; moderate). A definite diagnosis of bone infection usually requires positive results on microbiological (and, optimally, histological) examinations of an aseptically obtained bone sample, but this is usually required only when the diagnosis is in doubt or determining the causative pathogen's antibiotic susceptibility is crucial (strong; moderate). A probable diagnosis of bone infection is reasonable if there are positive results on a combination of diagnostic tests, such as probe‐to‐bone, serum inflammatory markers, plain X‐ray, magnetic resonance imaging (MRI) or radionuclide scanning (strong; weak). Avoid using results of soft tissue or sinus tract specimens for selecting antibiotic therapy for osteomyelitis as they do not accurately reflect bone culture results (strong; moderate). Obtain plain X‐rays of the foot in all cases of non‐superficial diabetic foot infection (strong; low). Use MRI when an advanced imaging test is needed for diagnosing diabetic foot osteomyelitis (strong; moderate). When MRI is not available or contraindicated, consider a white blood cell‐labelled radionuclide scan, or possibly single‐photon emission computed tomography (CT) and CT (SPECT/CT) or fluorine‐18‐fluorodeoxyglucose positron emission tomography/CT scans (weak; moderate). Assessing severity At initial evaluation of any infected foot, obtain vital signs and appropriate blood tests, debride the wound and probe and assess the depth and extent of the infection to establish its severity (strong; moderate). At initial evaluation, assess arterial perfusion and decide whether and when further vascular assessment or revascularization is needed (strong; low). Microbiological considerations Obtain cultures, preferably of a tissue specimen rather than a swab, of infected wounds to determine the causative microorganisms and their antibiotic sensitivity (strong; high). Do not obtain repeat cultures unless the patient is not clinically responding to treatment, or occasionally for infection control surveillance of resistant pathogens (strong; low). Send collected specimens to the microbiology laboratory promptly, in sterile transport containers, accompanied by clinical information on the type of specimen and location of the wound (strong; low). Surgical treatment Consult...

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“…An additional large, welldesigned prospective study could largely answer the question. 6. Is there a definition and practical clinical use for the concept of wound 'bacterial bioburden'?…”

Section: How Should We Adapt Approaches To Dfi Management In Low-incomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

495

561

View full text Add to dashboard Cite

show abstract

“…A systematic, evidence‐based approach to managing DFIs likely improves outcomes, specifically resolution of infection, and helps avoid complications, such as lower extremity amputation. This is best delivered by interdisciplinary teams, which should include among the membership, whenever possible, an infectious diseases or clinical/medical microbiology specialist . This team should, of course, also attempt to ensure optimal local wound care (eg, cleansing and debridement), pressure off‐loading, vascular assessment and treatment if needed, and metabolic (particularly glycaemic) control.…”

Section: Introductionmentioning

confidence: 99%

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

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

548

729

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

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“…The presence of psychologist and the sociologist in the multidisciplinary teams would help the better solving research team can radically improve and optimize as well as maximize the outcomes and findings of the clinical research, but this collaboration and multidisciplinary interaction is majorly missing from the clinical scenario of the country (Paisley et al, 2012). The physicians are the only clinicians who by a huge margin, gets a highest opportunity to undertake the medical and surgical clinical research while in the real-world care scenarios, there are a lot of other professionals like the nurses and allied health care experts who take active part in the care management of patient.…”

Section: Methodsmentioning

confidence: 99%

Development, maintenance and regulation of multidisciplinary research teams to improve clinical research quality in India - implications for HR practice

Roy¹

2022

IJSREM

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The overall quality of the clinical research is low in India and there are number of social determinants of health, cultural, institutional, fiscal, financial plus technological factors that affects the performance and management of clinical researchers. The study focuses to understand the important effects of the multidisciplinary clinical research teams and human resource management on the outcomes of the clinical research. The study uses systematic review and thematic analysis as the methodology in order to understand the research problem in detail and provide solutions to the clinical research problems in the country. A total of scholarly 21 articles has been systematically reviewed and four major themes has been found out. The study finds out multiple complex factors that ranges from technical, professional, personal, social, cultural dimensions to institutional and organizational types that needs to be addressed, in order to improve the quality of clinical and medical research in the country. The translational and the implementation sciences has been found to play a critical role in clinical research and the academic-industry collaborations is necessary too. The human resource management plays a cardinal role in the whole undertaken of the clinical research process that has been explained in the research study. The implications of the human resource management and the clinical research management has been mentioned as well, that is to be considered very closely.

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Real time presence of a microbiologist in a multidisciplinary diabetes foot clinic

Cited by 8 publications

References 15 publications

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

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

Development, maintenance and regulation of multidisciplinary research teams to improve clinical research quality in India - implications for HR practice

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