RESUMEN
INTRODUCTION: Optimal treatment duration for residual osteomyelitis (OM) post-amputation in diabetic foot infection (DFI) remains unclear, with resultant heterogeneity in prescribing noted in clinical practice. We aimed to identify a difference in outcomes of long duration of antibiotics (LD) with short duration (SD) in patients with culture-positive proximal bone specimen post-amputation. METHODS: In this single-centre retrospective cohort study (Melbourne, Australia), we analysed antibiotic duration of DFI patients requiring amputation with culture-positive proximal bone specimen over a 31â month period (January 2019-September 2021). Primary outcome was reamputation or debridement at the same and/or contiguous site of amputation at 6â months. Secondary outcomes were readmission to hospital and/or recommencement of antibiotics for DFI at the same and/or contiguous site at 6â months. RESULTS: Among 92 patients (83% male, median age 67â years), 26 received <4â weeks (SD) and 66 received ≥4â weeks (LD) antibiotic therapy. In the SD group, primary outcome occurred in 9 patients (35%) compared with 15 patients (23%) in the LD group (Pâ=â0.246). Both secondary outcomes occurred in 12 patients (46%) in the SD group compared with 18 patients (27%) in the LD group (Pâ=â0.086). Adjusted logistic regression analysis showed SD was not significantly associated with primary outcome [OR 1.12 (95% CI 0.38-3.31)] or secondary outcomes [OR 1.67 (95% CI 0.60-4.66)]. CONCLUSIONS: This single-centre experience did not demonstrate significant difference in outcomes between antibiotic duration of <4â weeks and ≥4â weeks in DFI patients with culture-positive proximal bone specimen post-amputation. These data provide background for larger international randomized control trials to establish optimal treatment duration.
Asunto(s)
Enfermedades Transmisibles , Diabetes Mellitus , Pie Diabético , Osteomielitis , Humanos , Masculino , Anciano , Femenino , Estudios Retrospectivos , Pie Diabético/complicaciones , Pie Diabético/tratamiento farmacológico , Pie Diabético/cirugía , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugía , Antibacterianos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológicoRESUMEN
Background: In patients with spinal cord injuries (SCIs), infections continue to be a leading cause of morbidity, mortality and hospital admission. Objectives: This study evaluated the long-term impact of a weekly, multidisciplinary Spinal/Antimicrobial Stewardship (AMS) meeting for acute-care SCI inpatients, on antimicrobial prescribing over 3â years. Methods: A retrospective, longitudinal, pre-post comparison of antimicrobial prescribing was conducted at our tertiary hospital in Melbourne. Antimicrobial prescribing was audited in 6â month blocks pre- (25 April 2017 to 24 October 2017), immediately post- (27 March 2018 to 25 September 2018) and 3â years post-implementation (2 March 2021 to 31 August 2021). Antimicrobial orders for patients admitted under the spinal unit at the meeting time were included. Results: The number of SCI patients prescribed an antimicrobial at the time of the weekly meeting decreased by 40% at 3â years post-implementation [incidence rate ratio (IRR) 0.63; 95% CI 0.51-0.79; P ≤ 0.001]. The overall number of antimicrobial orders decreased by over 22% at 3â years post-implementation (IRR 0.78; 95% CI 0.61-1.00; Pâ=â0.052). A shorter antimicrobial order duration in the 3â year post-implementation period was observed (-28%; 95% CI -39% to -15%; P ≤ 0.001). This was most noticeable in IV orders at 3â years (-36%; 95% CI -51% to -16%; Pâ=â0.001), and was also observed for oral orders at 3â years (-25%; 95% CI -38% to -10%; Pâ=â0.003). Antimicrobial course duration (days) decreased for multiple indications: skin and soft tissue infections (-43%; 95% CI -67% to -1%; Pâ=â0.045), pulmonary infections (-45%; 95% CI -67% to -9%; Pâ=â0.022) and urinary infections (-31%; 95% CI -47% to -9%; Pâ=â0.009). Ninety-day mortality rates were not impacted. Conclusions: This study showed that consistent, collaborative meetings between the Spinal and AMS teams can reduce antimicrobial exposure for acute-care SCI patients without adversely impacting 90â day mortality.