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Adjunctive Rifampin Therapy For Diabetic Foot Osteomyelitis in the Veterans Health Administration.
Wilson, Brigid M; Bessesen, Mary T; Doros, Gheorghe; Brown, Sheldon T; Saade, Elie; Hermos, John; Perez, Federico; Skalweit, Marion; Spellberg, Brad; Bonomo, Robert A.
Afiliação
  • Wilson BM; Research Service and Geriatric Research, Education, and Clinical Center (GRECC),VA Northeast Ohio Healthcare System, Cleveland.
  • Bessesen MT; Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Doros G; Division of Infectious Diseases, University of Colorado, Denver, School of Medicine, Department of Veterans Affairs Eastern Colorado Healthcare System, Aurora.
  • Brown ST; Massachusetts Veterans Epidemiology Research and Information Center, Boston.
  • Saade E; Boston University School of Medicine, Boston, Massachusetts.
  • Hermos J; James J. Peters Veterans Affairs Medical Center, Bronx, New York.
  • Perez F; Icahn School of Medicine at Mount Sinai, New York, New York.
  • Skalweit M; Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Spellberg B; Research Service, VA Northeast Ohio Healthcare System, Cleveland.
  • Bonomo RA; University Hospitals of Cleveland, Cleveland, Ohio.
JAMA Netw Open ; 2(11): e1916003, 2019 11 01.
Article em En | MEDLINE | ID: mdl-31755948
Importance: Among patients diagnosed with diabetes, the lifetime incidence of foot ulcers is 15%. Infection is a common complication of foot ulcers, and 20% to 60% of infections result in diabetic foot osteomyelitis (DFO). Current treatment guidelines do not endorse any specific antibiotic agent for DFO, but small clinical trials suggest the addition of rifampin to antimicrobial regimens results in improved cure rates for osteomyelitis. Objective: To compare the clinical outcomes of patients treated for DFO in the Veterans Health Administration (VHA) with and without adjunctive rifampin. Design, Setting, and Participants: This observational cohort study used VHA databases to identify index DFO cases from January 1, 2009, through December 31, 2013, and analyzed patients alive and without high-level amputation at 90 days after diagnosis in whom antibiotic therapy was initiated within 6 weeks of diagnosis. Patients with death or major amputation within 90 days of diagnosis, who were not treated with systemic antibiotics dispensed by the VHA within 6 weeks of diagnosis, or who were treated at facilities where rifampin was not dispensed for DFO were excluded. The retrospective cohort to inform the planning of a multisite randomized clinical trial was first investigated in spring 2015; retrospective analysis was performed from February 2017 through September 2019. Exposures: Patients initiating rifampin therapy within 6 weeks of the DFO diagnosis and receiving the drug for at least 14 days within 90 days of diagnosis were considered treated with rifampin. Patients not administered rifampin within 90 days of diagnosis served as the comparator group. Main Outcomes and Measures: A combined end point of mortality or amputation within 2 years of diagnosis was analyzed. Differences in times to event were evaluated using log-rank tests. Differences in event rates were compared using χ2 tests and multivariable logistic regression. Results: The analysis population included 130 patients treated with rifampin and 6044 treated without rifampin (total of 6174; 6085 men [98.6%]; mean [SD] age, 64.9 [9.7] years). Lower event rates were observed among the rifampin group (35 of 130 [26.9%] vs 2250 of 6044 [37.2%]; P = .02). Patients treated with rifampin were younger (mean [SD] age, 62.2 [9.4] vs 64.9 [9.6] years), had fewer comorbidities (mean [SD] Charlson comorbidity index score, 3.5 [1.8] vs 4.0 [2.2]), had more infectious disease specialty consultations (63 of 130 [48.5%] vs 1960 of 6044 [32.4%]), and more often had Staphylococcus aureus identified in cultures (55 of 130 [42.3%] vs 1755 of 6044 [29.0%]) than patients not treated with rifampin. A logistic regression estimating the odds of events and controlling for these and other covariates yielded a significant association of rifampin (odds ratio, 0.65; 95% CI, 0.43-0.96; P = .04). Conclusions and Relevance: In this cohort study, patients administered rifampin experienced lower rates of death and amputation than patients not treated with rifampin, which remained significant after adjustment for confounders. These results coupled with existing evidence from small clinical trials suggest the addition of rifampin to current treatment regimens may be a useful antimicrobial option in the treatment of DFO.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteomielite / Rifampina / Pé Diabético / Serviços de Saúde para Veteranos Militares / Antibacterianos Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteomielite / Rifampina / Pé Diabético / Serviços de Saúde para Veteranos Militares / Antibacterianos Tipo de estudo: Clinical_trials / Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2019 Tipo de documento: Article