316. Joint Initiative Between Infectious Diseases and Podiatry in Outpatient Settings Improves Diabetic Foot Infection Patients’ Compliance and Outcomes

Abstract

BackgroundMany patients with diabetic foot infections (DFI) face challenges with keeping their follow-up appointments. This can result in recurrent DFI. A joint, Infectious Diseases-Podiatry clinic (JIDPC) that an Infectious Diseases (ID) physician and a Podiatrist see their patients together in wound care center once a week was initiated in January 2017. This study was designed to investigate if JIDPC can improve patient compliance and outcomes.MethodsA retrospective analysis of the patients admitted to Wheeling Hospital with DFI from March 2013 to December 2017 and required post discharge follow-up by ID and Podiatry was performed. Initially, they were followed by ID and Podiatry in their clinics separately (preintervention group). Beginning January 2017, they were followed together at the JIDPC (postintervention group). Recurrent infection, mortality, and lost to follow-up were compared between the two groups using logistic regression models adjusting for age and sex.ResultsAmong 119 patients, 85 patients were in preintervention group and 34 patients were in postintervention group. Surgeries were performed in 47.1% of preintervention group and 85.3% of postintervention group (P < 0.001) (Table 1). Risk of recurrence in 6 months was significantly higher in preintervention group (odds ratio [OR] = 3.14 [1.07, 9.24]), but with further adjustment for surgery, P-value was 0.05 (OR = 3.08 [0.98–9.62]). Preintervention group was more likely to be lost to follow-up (OR = 3.67 [1.16–11.59]), but the association was attenuated with further adjustment for surgery (OR = 2.17 [0.64–7.41]). Re-admission in 90 days and mortality rate were not significantly different.ConclusionImplementation of JIDPC would be effective to decrease the incidence of recurrent infections among DFI.Table 1: Clinical Characteristics and Comparison Between Pre- and Postintervention GroupsPreintervention Group (n = 85)Postintervention Group (n = 34)Characteristic P-ValueNo.(%)No.(%)Male sex6677.72676.50.890Age ≥653035.31750.00.138Osteomyelitis6677.72882.40.569Surgery4047.12985.3<.001Peripheral vascular disease2833.01132.40.859Kidney dysfunction3440.01235.30.634Poorly controlled diabetes3743.51441.20.815Lost follow-up2731.8411.80.025Re-admission2731.81235.30.711Death44.725.91.000Recurrent Infection in 6 months3136.5516.70.044Disclosures All authors: No reported disclosures.