514-P: A 13-Year Retrospective Analysis of an Admission-Avoidance Strategy Using Intramuscular Antibiotics in Treating “Borderline-Severe“ Diabetic Foot Infections

Abstract

Aim: To determine the outcomes of using intramuscular (IM) antibiotics as an admittance avoidance strategy in people presenting with a ‘borderline-severe’ diabetic foot infection. Methods: Methods:122 patients (accounting for 141 episodes) were treated for ‘borderline-severe infection’ between January 2009 and April 2022. Prior to the introduction of this service they would have required an acute hospital admission. Individuals were followed up to determine whether the use of intramuscular antibiotics had prevented acute hospital admission. Results: Our clinic saw, on average, 420 contacts per month during the study period. Approximately 5 people per week were admitted directly from specialist clinics or the emergency department with a severe infection. Of those seen in the specialist foot clinic, only 1 person per month was deemed appropriate to receive IM treatment. These had a mean age (±SD) of 61 years (13.3), and 83% were male, and 25% had type 1 diabetes. The mean (IQR) number of injections was 5.5 (6.0). Of these, 39/141 subsequently needed hospital admission. The remaining 102 people were successfully treated as outpatients, with 95 ulcers healing. Of the 39 admissions, 20 needed IV antibiotics alone, 14 had a minor amputation, 5 had a major amputation. Conclusions: Admission avoidance strategies are increasing important in reducing the pressure on hospitals beds. Like others, our hospital increasingly uses outpatient intravenous antibiotic services, but that has its own pressures. We now successfully use either IV or IM administration to treat borderline-severe diabetic foot infections depending on the capacity of either service, thus avoiding acute hospital admission which leads to significant cost savings. Disclosure K.Dhatariya: Other Relationship; Novo Nordisk, AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company. C.Gooday: Speaker's Bureau; AstraZeneca. A.H.Fung: None.