Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians

• Published in: Journal of foot and ankle research Vol. 11; no. 1; pp. 13 - n/a
• Main Authors: Commons, Robert J., Raby, Edward, Athan, Eugene, Bhally, Hasan, Chen, Sharon, Guy, Stephen, Ingram, Paul R., Lai, Katy, Lemoh, Chris, Lim, Lyn‐Li, Manning, Laurens, Miyakis, Spiros, O'Reilly, Mary, Roberts, Adam, Sehu, Marjoree, Torda, Adrienne, Vicaretti, Mauro, Lazzarini, Peter A.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 10-04-2018; BioMed Central Ltd; Wiley
• Subjects: Administration, Oral; Anti-Bacterial Agents - administration & dosage; Australia; Australia - epidemiology; Bacterial Infections - complications; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Care and treatment; Clinical Competence; Cross-Sectional Studies; Diabetes mellitus; Diabetic foot; Diabetic Foot - complications; Diabetic Foot - drug therapy; Diabetic Foot - epidemiology; Diabetic foot infection; Drug Administration Schedule; Drug Utilization - statistics & numerical data; Health Care Surveys; Humans; Infectious diseases; Infusions, Intravenous; New Zealand; New Zealand - epidemiology; Patient Care Team - organization & administration; Physician; Physicians; Practice; Professional Practice - statistics & numerical data; Surveys; Workload - statistics & numerical data; Australia; New Zealand; Physician; Infectious diseases; Diabetic foot infection; Australia; Diabetes mellitus
• ISSN: 1757-1146; 1757-1146
• DOI: 10.1186/s13047-018-0256-3

Background
Diabetic 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.
Methods
A 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.
Results
Approximately 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.
Conclusions
Patients 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.