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. 2018 Apr 10:11:13.
doi: 10.1186/s13047-018-0256-3. eCollection 2018.

Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians

Robert J Commons  1 , Edward Raby  2 , Eugene Athan  3 , Hasan Bhally  4 , Sharon Chen  5 , Stephen Guy  6   7 , Paul R Ingram  2   8 , Katy Lai  9 , Chris Lemoh  10 , Lyn-Li Lim  11 , Laurens Manning  12 , Spiros Miyakis  13 , Mary O'Reilly  11 , Adam Roberts  14 , Marjoree Sehu  15   16 , Adrienne Torda  17 , Mauro Vicaretti  18 , Peter A Lazzarini  19
Affiliations

Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians

Robert J Commons et al. J Foot Ankle Res. .

Abstract

Background: Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand.

Methods: A cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians' management practices of patients with DFIs.

Results: Approximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely.

Conclusions: Patients with DFIs represent a significant proportion of an ID clinician's caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.

Keywords: Australia; Diabetes mellitus; Diabetic foot infection; Infectious diseases; New Zealand; Physician.

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Conflict of interest statement

This project was conducted as a quality initiative benchmarking current practice against the national therapeutic guidelines. Participants were aware of the nature of the project. Case vignettes were written specifically for this project and contained no real patient information. Ethical approval was not required for this survey of health professionals as it was assessed to have no ethical risk.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Type of antibiotics and duration chosen by respondents (n = 106) for Scenario 1. IV = intravenous; = PO per oral. † includes one each of ceftazidime and flucloxacillin; ceftazidime; flucloxacillin and gentamicin. ‡ includes one each of clindamycin; flucloxacillin and trimethoprim-sulfamethoxazole; trimethoprim-sulfamethoxazole and moxifloxacin; flucloxacillin
Fig. 2
Fig. 2
Type of antibiotics and duration chosen by respondents (n = 106) for Scenario 2. IV = intravenous; = PO per oral
See this image and copyright information in PMC

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