1144 Audit of Microbiological Sampling in Patients with Diabetic Foot Infections Presenting to a Tertiary Vascular Centre in the North-East of England

Abstract

Abstract Aim To identify the practice of microbiology sampling in patients presenting to a Tertiary Vascular Centre in the North East of England in accordance with NICE guideline (NG19) ‘Diabetic foot problems: prevention and management’ and the ‘International Working Group on the Diabetic Foot guidance on the diagnosis and management of foot infections in diabetes’. Method A two-part retrospective audit was completed before and after the introduction of a podiatrist-led 'Hot Foot Clinic'. Patients were identified from the surgical-take handover and admission database by using keywords ‘diabetic’, ‘cellulitis’, ‘erythema’, ‘pain’, ‘wet necrosis’, ‘collection’, 'osteomyelitis’. Route of admission, timing and type of microbial samples and date of antibiotics prescribed were recorded. Results In the first cycle 56.8% (21/37) patients had microbiology samples sent. 47.6% (10/21) of these were sent before antibiotic prescription. 8.1% (3/37) had both a swab and tissue sample taken. 35.1% (13/37) had tissue samples and 21.6% (5/37) had swabs. In the second cycle 74.2% (23/31) had microbiology samples sent. In patients who had tissue samples taken, 23.5% (4/17) were prior to antibiotic initiation. All patients (3/3) admitted from a podiatry-led ‘Hot Foot Clinic’ had microbiology taken prior to antibiotics. 6.3% (1/16) patients admitted through the clinician-led Emergency Admissions Suite had microbiology taken before antibiotics. Conclusions Despite introducing a podiatrist-led clinic, reinforcement of correct microbiological sampling in diabetic foot infections is required for accurate diagnosis and optimal treatment. Further specialist input and audio-visual educational material is being developed to improve practice amongst all staff.