Foot infections in diabetes (DFIs) in the out-patient setting: An Italian multicentre observational survey

S. Esposito, S. Leone, S. Noviello, M. Fiore, F. Ianniello, F. M. Felaco, F. Romagnoli, E. Sarli

Research output: Contribution to journalArticle

Abstract

Aims: To conduct a multicentre observational study to describe management of foot infections in diabetes in the out-patient setting in Italy. Patients and methods: Ten centres equally distributed nationwide were asked to collect, by means of a spreadsheet (Access/Excel Microsoft program), data concerning 30 consecutive diabetic patients with foot infections deemed suitable for antibiotic treatment in the out-patient setting. Centres with ≥ 5 years' experience of out-patient management were selected. Data from 271 consecutive patients treated as out-patients were collected and analysed by the central coordinator. Statistical analysis was performed using the SPSS statistical software package. Results: Lesions were mainly located at the toes and midfoot (33.6 and 30.2%, respectively); 63 (23.2%) patients had multiple ulcers. Seventy (25.8%) patients also had concomitant osteomyelitis. Three hundred and four pathogens, including Gram-positive and Gram-negative aerobes and anaerobes, were isolated in 219/271 patients (80.8%) by culturing debrided tissue (71.2%) or purulent material (28.8%). Infections were polymicrobial in 33.8% of patients. The most common pathogens were Staphylococcus aureus (27.3%) and Pseudomonas spp. (20.4%); enterobacteriaceae, enterococci, streptococci and anaerobes accounted for 11.5, 7.6, 6.9 and 1.9%, respectively. Antibiotics were frequently administered by parenteral route and frequently in combination. Piperacillin/tazobactam was the parenteral antibiotic most frequently utilized (21.1%). Cure/improvement was observed in 93.4% of patients. Conclusions: Foot ulcers in diabetes are common and serious; the aetiology is often polymicrobial, often including S. aureus and Pseudomonas spp. Treatment in the out-patient setting is safe and effective, and penicillins together with β-lactamase inhibitors and fluoroquinolones are the most frequent choice.

Original languageEnglish
Pages (from-to)979-984
Number of pages6
JournalDiabetic Medicine
Volume25
Issue number8
DOIs
Publication statusPublished - Aug 2008

Keywords

  • Diabetic foot infections
  • Out-patient setting
  • Piperacillin/tazobactam
  • Pseudomonas spp.

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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