A Comparative Analysis of Antibiotic Usage in Diabetic Foot Infections Against Healing Time

Abstract

The study aimed to analyze bacterial flora in diabetic foot infection, empiric and targeted antibiotic therapy, and factors influencing wound healing duration. The study we undertook a review analysis of data in 118 cases of diabetic foot among 98 patients who reported to the Wound Care Clinic in Warsaw, Poland between 01/2014 and 12/2018. Collected data included sociodemographic data, wounds information, used treatment, results of the microbiological examination, and empiric and targeted antibiotic therapy. For purposes of identifying the empirical and targeted antibiotic compatibility, the patients were divided into subgroups: ETA+ (compatibility of empiric-targeted antibiotic), ETA- (non-compatibility of empiric-targeted antibiotic), NEA (no empiric antibiotic), and NTA (no targeted antibiotic). The study group consisted of men, N = 71 (72.4%) and women, N = 27 (27.6%). Twenty patients (20.4%) were diagnosed as obese according to the body mass index classification. Staphylococcus aureus and Enterococcus faecalis were identified in most cases [N = 53 (24.4%), and N = 41 (18.9%), respectively]. Sixteen patients (13.6%) received gentamycin locally. Amoxicillin with clavulanic acid, clindamycin, and levofloxacin were the most frequently used antibiotics as empiric therapy; meanwhile, in targeted therapy, amoxicillin with clavulanic acid and levofloxacin were most frequently used. Empiric and targeted antibiotic therapies were compatible in 65 (55.1%) cases. The duration of healing did not differ between selected subgroups, and was longer in obese patients (p = .001). Other variables did not influence the healing time. The use of empiric antibiotic therapy before targeted therapy and the topical use of gentamycin did not reduce the healing time of diabetic foot infection. The healing time of diabetic foot infection was longer in obese patients than in nonobese patients.