Impact of a Multidisciplinary Approach to Diabetic Foot Infections: The Design of a New Orthopedic Department, Stringent Practices, and Diagnostic Methods

Abstract

BACKGROUND Diabetic foot infections (DFIs) are associated with major morbidity and mortality. Many different organisms can cause DFIs. Accurate identification of bacteria involved in DFIs is crucial for accurate treatment. Opening a second orthopedic department provided the opportunity to implement new practices. METHODS An intervention study employing a retrospective (pre-intervention) and prospective (intervention) cohort data. Pre-intervention period (2015-2016) included one orthopedic department, DFI patients located in separate rooms within the orthopedic department. Intervention period (2017) included a multifaceted strategy, including: a separate complicated wound unit within the new orthopedic department for DFI patients; local infection control guidelines updated; a dedicated infection control nurse assigned; writing guidelines for diabetic foot sample culturing; implementing antibiotic stewardship; conducting a weekly multidisciplinary-team grand round; and post-discharge outpatient follow-up. Data of DFI patients' medical records were collected including type of culture, culture results, length of in-hospital stay, and mortality. RESULTS 314 patients with DFI were hospitalized; 101 (61±14y/o, 77% male) during the pre-intervention and 213 (62±12y/o, 74% male) during the intervention period. Demographic characteristics, blood-tests on admission, and osteomyelitis rates were similar in both periods. During the intervention vs. pre-intervention period: fewer underwent surgery (71.8% vs. 94.1%, P CONCLUSIONS A multidisciplinary approach to DFI patients in an orthopedic department decreased surgical procedures, increased antibiotic stewardship, and increased the prevalence of sensitive bacterial isolates.