Management of Patients Hospitalized for Diabetic Foot Infection: A Local Evaluation
AbstractBackground: Diabetic foot ulcer (DFU) is the most frequent complication of DM with an upward trend over the last two decades.The present study was implemented to determine how DFU was managed in a major referral hospital in Isfahan.Methods: This prospective cross-sectional study was conducted from the 1st July 2016 to 15th December 2017 in Al-Zahra Hospital, in Isfahan, Iran. The information was collected by atrained pharmacy student by recordingbaseline characteristics of patients, current approach to investigate the DFU, management of the infected wound, and assessment of risk factors related to patients' outcomes.Results: The mean (±S.D) age of patients was 59.13±10.80 years. The majority of our patients had affected with Type 2 DM (96.3 %). Most of the patient (61%) had wound with grade 3 in the Wagner classification. Lesions mainly involved toes (46.3%). The most lesions (42%) had a mean size of the 5-10 cm2.The most frequently prescribed combination antibiotics were meropenem and Targocid® (teicoplanin) (34.1%), Tazocin® (piperacillin + tazobactam) and Targocid® (24.3%). Mean (±SD) duration of parenteral therapy (alone or in associated with oral treatment) was 14.95±7.62 days. Ulcer size (cm2) (P=0.04), and Wagner classification (P=0.012) had significant association with unhealed ulcer. Conclusion: Although, our diabetic center is university-affiliated, there are still several points, and pitfalls must be considered and revised in DFU patients. Obtaining microbiological sampling, antibiotic management and baseline assessment of wound in patients are the most troublesome complications discovered by our investigation.
Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classification consensus of International Working Group on Diabetic Foot (IWGDF). Pak J Med Sci 2013;29(3):730.
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94(3):311-321.
Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet 2005;366(9498):1725-1735.
Leone S, Pascale R, Vitale M, Esposito S. Epidemiology of diabetic foot. Infez Med 2012;20(Suppl 1):8-13.
Aalaa M, Malazy OT, Sanjari M, Peimani M, Mohajeri-Tehrani M. Nurses’ role in diabetic foot prevention and care; a review. J Diabetes Metab Disord 2012;11(1):24.
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes 2015;6(1):37-53.
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93.
Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273(9):721-3.
Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: part II. Management. J Am Acad Dermatol 2014 ;70(1):21.e1-24; quiz 45-6.
Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep 2003;3(6):475-9.
DiPreta JA. Outpatient assessment and management of the diabetic foot. Med Clin North Am 2014;98(2):353-73.
Seaman S. The role of the nurse specialist in the care of patients with diabetic foot ulcers. Foot Ankle Int 2005;26(1):19-26.
Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis 2012;54(12):e132-e173.
Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004;39(7):885-910.
Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev 2004;20(S1): S68-S77.
Wagner Jr FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981;2(2):64-122.
Dezfulian A, Salehian M, Amini V, et al. Bacteriological study of diabetic foot infections in an Iranian hospital. Iran Red Crescent Med J 2011;13(8):590-1.
Richard J-L, Lavigne J-P, Got I, et al. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab 2011;37(3):208-15.
Oyibo S, Jude E, Tarawneh I, et al. The effects of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med 2001;18(2):133-8.
Vazin A, Japoni A, Shahbazi S, Davarpanah MA. Vancomycin utilization evaluation at hematology-oncology ward of a teaching hospital in Iran. Iran J Pharm Res 2012;11(1):163-70.
Mousavi S, Behi M, Taghavi MR, Ahmadvand A, Ziaie S, Moradi M. Drug utilization evaluation of imipenem and intravenous ciprofloxacin in a teaching hospital. Iran J Pharm Res 2013;12 (suppl):161-7.
Salehifar E, Shiva A, Moshayedi M, Kashi TS, Chabra A. Drug use evaluation of Meropenem at a tertiary care university hospital: a report from Northern Iran. J Res Pharm Pract 2015;4(4):222-5