The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

Saltoğlu, Neşe; Sürme, Serkan; Ezirmik, Elif; Kadanalı, Ayten; Kurt, Ahmet; Özdemir, Meryem; Ak, Öznur; Altay, Fatma Aybala; Acar, Ali; Çakar, Zeynep Şule; Tülek, Necla; Kinikli, Sami

doi:10.1177/15347346211004141

Cited by 16 publications

(25 citation statements)

References 29 publications

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“…144 But, as these antibiotics are often used in more severe or nonresponsive cases, it is difficult to draw clear conclusions. 144 Given the paucity of data on the resolution of infection, recurrence of infection, and the acquisition of antimicrobial resistance, our recommendation is to choose any of the systemic antibiotic regimens that have shown to be effective in published randomised controlled trials to treat a patient with diabetes and a soft tissue infection of the foot. Antibiotic dosing for skin and soft tissue infection is usually standard, but therapy for DFO may require higher doses than standard doses.…”

Section: Rationalementioning

confidence: 99%

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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Section: Rationalementioning

confidence: 99%

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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“…43,44 Following our 2019 review, we identified 3 additional, recent papers that compared the efficacy of different systemic antibiotics for the treatment of ST-DFIs. 14,21,33 In a series of 794 initial episodes of DFIs in 419 patients, including 339 episodes of DFO, all patients were treated with surgical debridement. 14 Beta-lactam antibiotics were used in 631 episodes (79%) including oral amoxicillinclavulanate at a daily dose ranging from 2 to 3 g for a median of 20 days (interquartile range, 12-30 days) in 301 episodes.…”

Section: Summary Of the Literaturementioning

confidence: 99%

“…This limitation makes it difficult to draw reliable conclusions. 33 We added 'acquisition of antimicrobial resistance' in the 2023 PICO, a term that was not included in the 2019 PICO. We did not find outcome data for antimicrobial resistance in the extracted data of the papers identified in the 2019 systematic review.…”

Section: Summary Of the Literaturementioning

confidence: 99%

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Interventions in the management of diabetes‐related foot infections: A systematic review

Peters,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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The optimal approaches to managing diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high‐quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of diabetic foot infections from 30 June 2018 to 30 June 2022. We combined this search with our previous literature search of a systematic review performed in 2020, in which the infection committee of the International Working Group on the Diabetic Foot searched the literature until June 2018. We defined the context of the literature by formulating clinical questions of interest, then developing structured clinical questions (Patients‐Intervention‐Control‐Outcomes) to address these. We only included data from controlled studies of an intervention to prevent or cure a diabetic foot infection. Two independent reviewers selected articles for inclusion and then assessed their relevant outcomes and methodological quality. Our literature search identified a total of 5,418 articles, of which we selected 32 for full‐text review. Overall, the newly available studies we identified since 2018 do not significantly modify the body of the 2020 statements for the interventions in the management of diabetes‐related foot infections. The recent data confirm that outcomes in patients treated with the different antibiotic regimens for both skin and soft tissue infection and osteomyelitis of the diabetes‐related foot are broadly equivalent across studies, with a few exceptions (tigecycline not non‐inferior to ertapenem [±vancomycin]). The newly available data suggest that antibiotic therapy following surgical debridement for moderate or severe infections could be reduced to 10 days and to 3 weeks for osteomyelitis following surgical debridement of bone. Similar outcomes were reported in studies comparing primarily surgical and predominantly antibiotic treatment strategies in selected patients with diabetic foot osteomyelitis. There is insufficient high‐quality evidence to assess the effect of various recent adjunctive therapies, such as cold plasma for infected foot ulcers and bioactive glass for osteomyelitis. Our updated systematic review confirms a trend to a better quality of the most recent trials and the need for further well‐designed trials to produce higher quality evidence to underpin our recommendations.

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“…Although there is insufficient evidence that MDRO delay wound healing, 15 some studies have shown that MDRO significantly increase the rate of recurrence and amputation in patients with DFU. 16 , 17 There are significant differences in the prevalence of MDROs in different regions, 18–21 and there are few reports on the prevalence of MDROs in DFU in North China. The aim of this study is to analyze the microbiological characteristics of DFU and drug resistance of MDROs, and to reveal the potential risk factors for MDROs.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer

Liu¹,

Ren

Zhai³

et al. 2022

IDR

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Objective The aim of this study is to analyze the microbiological characteristics of diabetic foot ulcer (DFU) and drug resistance of multidrug-resistant organisms (MDROs) and to reveal the potential risk factors for MDROs. This provides a basis for early empiric antibiotic treatment. Methods This study included 348 patients with diabetic foot ulcer in Chu Hsien-I Memorial Hospital & Metabolic Disease Hospital of Tianjin Medical University between May 2020 and November 2021. A total of 475 strains of bacteria were cultured, among which 240 strains were multidrug-resistant bacteria, accounting for 51%. Binary logistic regression was used to analyze risk factors. First, univariate analysis was used to calculate the p value of variables, and then multivariate analysis was conducted for variables with p < 0.1 to analyze independent risk factors. Risk factors with p < 0.05 in multivariable analysis were considered as independent risk factors. The strength of the association was represented by odds ratio and 95% confidence interval. Results Univariable logistic regression analysis demonstrated that previous hospitalization, previous antibiotic therapy, ulcer size >4cm 2 , surgical therapy, D-dimer, and CRP were associated with MDRO infection in patients with DFU. Multivariate logistic regression analysis demonstrated that previous hospitalization (OR = 1.91; 95% CI = 1.11–3.28; p = 0.02), ulcer size >4cm 2 (OR = 1.68; 95% CI = 1.03–2.76; p = 0.04), surgical therapy (OR = 2.14; 95% CI = 1.03–4.47; p = 0.04), and CRP (OR = 1.01; 95% CI = 1.00–1.01; p = 0.03) were independent risk factors for MDROs infection in diabetic foot patients. Drug resistance analysis may indicate that the proportion and drug resistance rate of Acinetobacter baumannii in Tianjin, China, have changed. Conclusion Previous hospitalization, ulcer size >4cm 2 , surgical therapy and CRP were independent risk factors for MDROs infection in diabetic foot patients. Identifying these risk factors can help us identify the high-risk patients of diabetic foot with MDRO infection early. More attention to high-risk patients and more aggressive isolation precautions may reduce the incidence of MDRO infection in diabetic foot patients.

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The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

Cited by 16 publications

References 29 publications

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

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

Interventions in the management of diabetes‐related foot infections: A systematic review

Risk Factors for Multidrug-Resistant Organisms Infection in Diabetic Foot Ulcer

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