Diabetic foot infection: Antibiotic therapy and good practice recommendations

Nicholas D. Barwell; Marion C. Devers; Brian Kennon; Helen E. Hopkinson; Claire McDougall; Matthew J. Young; Hannah M. A. Robertson; Duncan Stang; Stephanie J. Dancer; Ronald Andrew Seaton; Graham P. Leese; on behalf of the Scottish Diabetes Foot Action Group

doi:10.1111/ijcp.13006

Diabetic foot infection: Antibiotic therapy and good practice recommendations

Nicholas D. Barwell (Lead / Corresponding author), Marion C. Devers, Brian Kennon, Helen E. Hopkinson, Claire McDougall, Matthew J. Young, Hannah M. A. Robertson, Duncan Stang, Stephanie J. Dancer, Ronald Andrew Seaton, Graham P. Leese, on behalf of the Scottish Diabetes Foot Action Group

Research output: Contribution to journal › Article › peer-review

59 Citations (Scopus)

Abstract

Background: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics. Even appropriate antibiotic treatment carries a risk of adverse events including the selection of resistant organisms.

Aims: Multidisciplinary clinical assessment of a diabetic foot infection is supported by the use of appropriate imaging modalities and deep tissue sampling, both of which are encouraged to enhance sampling accuracy. Narrow-spectrum, high dose, short duration antimicrobial therapy is ideal. Further clarity in these areas would be of benefit to clinicians involved in management of diabetic foot infections.

Methods: A combination of literature review with expert discussion was used to generate consensus on management of diabetic foot infection, with a specific focus on empirical antimicrobial therapy.

Results: Gram positive organisms represent the commonest pathogens in diabetic foot infection. However there are developing challenges in antimicrobial resistance and antibiotic availability.

Discussion: Recommendations for empirical therapy, including the choice of alternative oral agents and use of outpatient antibiotics would be of benefit to those involved in diabetic foot care.

Conclusion: This paper provides advice on empirical antibiotic therapy that may be used as a framework for local guideline development to support clinicians in the management of diabetic foot infection.

Original language	English
Article number	e13006
Pages (from-to)	1-10
Number of pages	10
Journal	International Journal of Clinical Practice
Volume	71
Issue number	10
Early online date	11 Sept 2017
DOIs	https://doi.org/10.1111/ijcp.13006
Publication status	Published - 6 Oct 2017

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Barwell, N. D., Devers, M. C., Kennon, B., Hopkinson, H. E., McDougall, C., Young, M. J., Robertson, H. M. A., Stang, D., Dancer, S. J., Seaton, R. A., Leese, G. P., & on behalf of the Scottish Diabetes Foot Action Group (2017). Diabetic foot infection: Antibiotic therapy and good practice recommendations. International Journal of Clinical Practice, 71(10), 1-10. Article e13006. https://doi.org/10.1111/ijcp.13006

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title = "Diabetic foot infection: Antibiotic therapy and good practice recommendations",

abstract = "Background: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic na{\"i}ve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics. Even appropriate antibiotic treatment carries a risk of adverse events including the selection of resistant organisms.Aims: Multidisciplinary clinical assessment of a diabetic foot infection is supported by the use of appropriate imaging modalities and deep tissue sampling, both of which are encouraged to enhance sampling accuracy. Narrow-spectrum, high dose, short duration antimicrobial therapy is ideal. Further clarity in these areas would be of benefit to clinicians involved in management of diabetic foot infections.Methods: A combination of literature review with expert discussion was used to generate consensus on management of diabetic foot infection, with a specific focus on empirical antimicrobial therapy.Results: Gram positive organisms represent the commonest pathogens in diabetic foot infection. However there are developing challenges in antimicrobial resistance and antibiotic availability.Discussion: Recommendations for empirical therapy, including the choice of alternative oral agents and use of outpatient antibiotics would be of benefit to those involved in diabetic foot care.Conclusion: This paper provides advice on empirical antibiotic therapy that may be used as a framework for local guideline development to support clinicians in the management of diabetic foot infection.",

author = "Barwell, {Nicholas D.} and Devers, {Marion C.} and Brian Kennon and Hopkinson, {Helen E.} and Claire McDougall and Young, {Matthew J.} and Robertson, {Hannah M. A.} and Duncan Stang and Dancer, {Stephanie J.} and Seaton, {Ronald Andrew} and Leese, {Graham P.} and {on behalf of the Scottish Diabetes Foot Action Group}",

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doi = "10.1111/ijcp.13006",

language = "English",

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Barwell, ND, Devers, MC, Kennon, B, Hopkinson, HE, McDougall, C, Young, MJ, Robertson, HMA, Stang, D, Dancer, SJ, Seaton, RA, Leese, GP & on behalf of the Scottish Diabetes Foot Action Group 2017, 'Diabetic foot infection: Antibiotic therapy and good practice recommendations', International Journal of Clinical Practice, vol. 71, no. 10, e13006, pp. 1-10. https://doi.org/10.1111/ijcp.13006

TY - JOUR

T1 - Diabetic foot infection

T2 - Antibiotic therapy and good practice recommendations

AU - Barwell, Nicholas D.

AU - Devers, Marion C.

AU - Kennon, Brian

AU - Hopkinson, Helen E.

AU - McDougall, Claire

AU - Young, Matthew J.

AU - Robertson, Hannah M. A.

AU - Stang, Duncan

AU - Dancer, Stephanie J.

AU - Seaton, Ronald Andrew

AU - Leese, Graham P.

AU - on behalf of the Scottish Diabetes Foot Action Group

PY - 2017/10/6

Y1 - 2017/10/6

N2 - Background: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics. Even appropriate antibiotic treatment carries a risk of adverse events including the selection of resistant organisms.Aims: Multidisciplinary clinical assessment of a diabetic foot infection is supported by the use of appropriate imaging modalities and deep tissue sampling, both of which are encouraged to enhance sampling accuracy. Narrow-spectrum, high dose, short duration antimicrobial therapy is ideal. Further clarity in these areas would be of benefit to clinicians involved in management of diabetic foot infections.Methods: A combination of literature review with expert discussion was used to generate consensus on management of diabetic foot infection, with a specific focus on empirical antimicrobial therapy.Results: Gram positive organisms represent the commonest pathogens in diabetic foot infection. However there are developing challenges in antimicrobial resistance and antibiotic availability.Discussion: Recommendations for empirical therapy, including the choice of alternative oral agents and use of outpatient antibiotics would be of benefit to those involved in diabetic foot care.Conclusion: This paper provides advice on empirical antibiotic therapy that may be used as a framework for local guideline development to support clinicians in the management of diabetic foot infection.

AB - Background: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics. Even appropriate antibiotic treatment carries a risk of adverse events including the selection of resistant organisms.Aims: Multidisciplinary clinical assessment of a diabetic foot infection is supported by the use of appropriate imaging modalities and deep tissue sampling, both of which are encouraged to enhance sampling accuracy. Narrow-spectrum, high dose, short duration antimicrobial therapy is ideal. Further clarity in these areas would be of benefit to clinicians involved in management of diabetic foot infections.Methods: A combination of literature review with expert discussion was used to generate consensus on management of diabetic foot infection, with a specific focus on empirical antimicrobial therapy.Results: Gram positive organisms represent the commonest pathogens in diabetic foot infection. However there are developing challenges in antimicrobial resistance and antibiotic availability.Discussion: Recommendations for empirical therapy, including the choice of alternative oral agents and use of outpatient antibiotics would be of benefit to those involved in diabetic foot care.Conclusion: This paper provides advice on empirical antibiotic therapy that may be used as a framework for local guideline development to support clinicians in the management of diabetic foot infection.

U2 - 10.1111/ijcp.13006

DO - 10.1111/ijcp.13006

M3 - Article

C2 - 28892282

SN - 1368-5031

VL - 71

SP - 1

EP - 10

JO - International Journal of Clinical Practice

JF - International Journal of Clinical Practice

IS - 10

M1 - e13006

ER -

Diabetic foot infection: Antibiotic therapy and good practice recommendations

Abstract

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