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Observational Study
. 2021 Feb 9;4(2):e00225.
doi: 10.1002/edm2.225. eCollection 2021 Apr.

How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation

Ilker Uçkay  1   2 , Dominique Holy  3 , Madlaina Schöni  2 , Felix W A Waibel  2 , Tudor Trache  2 , Jan Burkhard  3 , Thomas Böni  2 , Benjamin A Lipsky  4 , Martin C Berli  2
Affiliations
Observational Study

How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation

Ilker Uçkay et al. Endocrinol Diabetes Metab. .

Abstract

Introduction: The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino-penicillins and second-generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion.

Methods: In this prospective observational study, we separately asked 13 experienced (median 11 years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas.

Results: Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2-year period, the clinicians' predictive performance did not improve.

Conclusion: The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs.

Keywords: Pseudomonas aeruginosa; clinical prediction; diabetic foot infections.

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Conflict of interest statement

All authors declare that they have no conflict of interest with this work or any financial relationships relevant to this study.

Figures

FIGURE 1
FIGURE 1
Photograph of a diabetic patient with mixed infection of the foot due to Pseudomonas aeruginosa and three other pathogens. Please note the absence of a clear green colour around the infected and ischaemic skin. The colour is rather yellowish. Permitted by patient
FIGURE 2
FIGURE 2
Receiver operating characteristic (ROC) curve of the performance of the predilection of Pseudomonas aeruginosa in diabetic foot infection
FIGURE 3
FIGURE 3
The proportions of the correct prediction of Pseudomonas aeruginosa in diabetic foot infections (vertical axis) over the study period. Horizontal axis; stratified in blocks of 40 consecutive episodes. The arrows indicate the timing of the feedbacks of the interim results
See this image and copyright information in PMC

References

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