TITLE:
Portraying Diabetic Foot Ulcers: Comparative Evaluation of Diabetic Foot Infections versus Diabetic Foot Ulcers
AUTHORS:
Jamal Wadi Al Ramahi, Leen Sharqawi, Sarah AL-Najafi, Eman Awwad, Haya M. Al-Obaidi, Abdel Hafez Mohammad, Sara Nofal, Dina Riyadh Al-Janabi, Ibrahim Zuhair, Hamza Jamal Al-Masaeid, Mohammed Al-Ithawi, Dina Rasheed, Bellal O. Al-Far, Osama Al-Izi, Qutaiba Al-Bustanji
KEYWORDS:
Diabetic Foot Ulcers, Diabetic Limb Amputation, Antimicrobials Stewardship, Broad-Spectrum Antimicrobials in Diabetic Foot Ulcers
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.14 No.2,
April
25,
2024
ABSTRACT: Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials; we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers; no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.