Abstract
BackgroundDiabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand.MethodsA cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians’ management practices of patients with DFIs.ResultsApproximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely.ConclusionsPatients with DFIs represent a significant proportion of an ID clinician’s caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.
Highlights
Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector
We aimed to identify current patterns in the clinical management of patients with DFI by Adult Infectious Diseases (ID) Physicians and Advanced Trainees in Australia and New Zealand and to determine the relative caseload of patients with DFI in this population
Participants were from all Australian jurisdictions and six of 16 New Zealand regions
Summary
Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. The 2015 Australian National Diabetes Audit found that 3.4% of patients in diabetes centres had a current foot ulcer, a twofold increase since 2009 [5]. A recent meta-analysis reported an estimated 3.4% of inpatients are affected by DFI [8] with foot infections resulting in more hospitalisations than any other diabetes-related complication in Australia [9]. The creation of multidisciplinary teams (MDTs) and best practice guidelines have improved care of patients with ulcers and DFI [10] and have resulted in fewer diabetes foot-related hospitalisations and major amputations in some Australian centres [11, 12]. Current published management guidelines on DFI [13,14,15], are limited by a relative lack of published clinical trials comparing efficacy of various antimicrobial regimens [16].
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