Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review †
Abstract
1. Introduction
2. Methods
3. Case Review Standards
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Total Population n (%) | MDFT Centre 1 | MDFT Centre 2 | MDFT Centre 3 | MDFT Centre 4 | MDFT Centre 5 | MDFT Centre 6 | MDFT Centre 7 | MDFT Centre 8 |
---|---|---|---|---|---|---|---|---|---|
Patients (n = 40) | 40 | 5 | 5 | 5 | 5 | 5 | 5 | 5 | 5 |
Male n (%) | 34 (85%) | 5 (100%) | 5 (100%) | 4 (80%) | 5 (100%) | 4 (80%) | 3 (60%) | 4 (80%) | 4 (80%) |
Female n (%) | 6 (15%) | 0 (0%) | 0 (0%) | 1 (20%) | 0 (0%) | 1 (20%) | 2 (40%) | 1 (20%) | 1 (20%) |
Age at diagnosis of DFO, years, mean (SD) | Mean 62.3 (SD 13.0) | 59.4 (SD 9.2) | 71.6 (SD 8.2) | 53.4 (SD 14.6) | 68.2 (SD 13.2) | 62.6 (SD 14.7) | 64.6 (SD 12.4) | 60.6 (SD 9.6) | 58.2 (SD 10.7) |
Diabetes type I, II or other | Type 1 8 (20%) Male = 6 (15%) Female = 2 (5%) Type 2 31 (77.5%) Male = 27 (67.5%) Female = 4 (10%) Other 1 (2.5%) Male = 1 (1%) Female = 0 (0%) | Type 1 1 (20%) Type 2 4 (80%) | Type 1 0 (0%) Type 2 5 (100%) | Type 1 2 (40%) Type 2 3 (60%) | Type 1 0 (0%) Type 2 5 (100%) | Type 1 1 (20%) Type 2 4 (80%) | Type 1 1 (20%) Type 2 4 (80%) | Type 1 0 (0%) Type 2 4 (%) Other 1 (20%) | Type 1 3 (60%) Type 2 2 (40%) |
DFO: Digit | 33 (80.5%) | 4 | 3 | 5 | 4 | 4 | 5 | 4 | 4 |
DFO: Metatarsals | 5 (12.2%) | 1 | 3 | 0 | 0 | 0 | 0 | 0 | 1 |
DFO: Mid-foot | 2 (4.9%) | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 0 |
DFO: Calcaneus | 1 (2.4%) | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
TOTAL | MDFT Centre 1 | MDFT Centre 2 | MDFT Centre 3 | MDFT Centre 4 | MDFT Centre 5 | MDFT Centre 6 | MDFT Centre 7 | MDFT Centre 8 | |
---|---|---|---|---|---|---|---|---|---|
Oral | 26 (65%) | 3 (60%) | 5 (100%) | 4 (80%) | 3 (60%) | 2 (40%) | 3 (60%) | 4 (80%) | 2 (40%) |
IV | 14 (35%) | 2 (40%) | 0 (0%) | 1 (20%) | 2 (40%) | 3 (60%) | 2 (40%) | 1 (20%) | 3 (60%) |
Antibiotic(s) and Mode of Delivery | Frequency (n = 40) | Mild Allergic Reaction (Sensitivity) to Antibiotic(s) | Severe Allergic Reaction (Anaphylaxis) to Antibiotic(s) | Acute Kidney Injury (AKI) | Abnormal Liver Test | Clostridium Difficile |
---|---|---|---|---|---|---|
Ceftriaxone IV | 1 | 0 | 0 | 0 | 0 | 0 |
Ciprofloxacin oral | 2 | 0 | 0 | 0 | 0 | 0 |
Clindamycin oral | 1 | 0 | 0 | 0 | 0 | 0 |
Clindamycin and ciprofloxacin oral | 9 | 2 (5%) | 0 | 1 (2.5%) | 2 (5%) | 0 |
Clindamycin and meropenem IV | 1 | 0 | 0 | 0 | 0 | 0 |
Co-Amoxiclav oral | 2 | 0 | 0 | 0 | 0 | 0 |
Co-Amoxiclav IV | 3 | 0 | 0 | 0 | 0 | 0 |
Co-Amoxiclav and amoxicillin oral | 4 | 0 | 0 | 0 | 1 (2.5%) | 0 |
Co-trimoxazole IV | 1 | 0 | 0 | 0 | 0 | 0 |
Doxycycline oral | 1 | 1 (2.5%) | 0 | 0 | 0 | 0 |
Ertapenem and metronidazole IV | 1 | 1 (2.5%) | 0 | 0 | 0 | 0 |
Ertapenem and clindamycin IV | 1 | 0 | 0 | 0 | 0 | 0 |
Flucloxacillin oral | 3 | 1 (2.5%) | 0 | 0 | 0 | 0 |
Flucloxacillin and fusidic acid oral | 3 | 0 | 0 | 0 | 0 | 0 |
Flucloxacillin and metronidazole IV | 1 | 0 | 0 | 1 (2.5%) | 1 (2.5%) | 0 |
Linezolid oral | 1 | 0 | 0 | 0 | 0 | 0 |
Piperacillin/tazobactam IV | 2 | 0 | 0 | 0 | 0 | 0 |
Teicoplanin IV | 3 | 0 | 0 | 2 (5%) | 2 (5%) | 0 |
Total | 40 | 5 (12.5%) | 0 | 4 (10%) | 6 (15%) | 0 |
TOTAL N (%) | MDFT Centre 1 N (%) | MDFT Centre 2 N (%) | MDFT Centre 3 N (%) | MDFT Centre 4 N (%) | MDFT Centre 5 N (%) | MDFT Centre 6 N (%) | MDFT Centre 7 N (%) | MDFT Centre 8 N (%) | |
---|---|---|---|---|---|---|---|---|---|
X-ray | 37 (92.5%) | 5 (100%) | 4 (80%) | 5 (100%) | 5 (100%) | 3 (60%) | 5 (100%) | 5 (100%) | 5 (100%) |
MRI | 10 (25%) | 2 (40%) | 3 (60%) | 1 (20%) | 0 (0%) | 1 (20%) | 1 (20%) | 1 (20%) | 1 (20%) |
CT | 1 (2.5%) | 1 (20%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
SPECT-CT | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
18F-FDG PET/CT | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Radioisotope bone scan | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Total Number of Tests N (%) | MDFT Centre 1 N | MDFT Centre 2 N | MDFT Centre 3 N | MDFT Centre 4 N | MDFT Centre 5 N | MDFT Centre 6 N | MDFT Centre 7 N | MDFT Centre 8 N | |
---|---|---|---|---|---|---|---|---|---|
X-ray | 57 (83.8%) | 6 | 1 | 8 | 8 | 3 | 1 | 16 | 14 |
MRI | 10 (14.7%) | 2 | 3 | 1 | 0 | 1 | 1 | 1 | 1 |
CT | 1 (1.4%) | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
SPECT-CT | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
18F-FDG PET/CT | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Radioisotope bone scan | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Total number of investigations | 68 | 9 | 4 | 9 | 8 | 4 | 2 | 17 | 15 |
Total N (%) | MDFT Centre 1 N (%) | MDFT Centre 2 N (%) | MDFT Centre 3 N (%) | MDFT Centre 4 N (%) | MDFT Centre 5 N (%) | MDFT Centre 6 N (%) | MDFT Centre 7 N (%) | MDFT Centre 8 N (%) | |
---|---|---|---|---|---|---|---|---|---|
FBC | 32 (80%) | 5 (100%) | 0 (0%) | 5 (100%) | 5 (100%) | 4 (80%) | 3 (60%) | 5 (100%) | 5 (100%) |
eGFR | 34 (85%) | 5 (100%) | 0 (0%) | 5 (100%) | 5 (100%) | 5 (100%) | 4(80%) | 5 (100%) | 5 (100%) |
U&E profile | 28 (70%) | 5 (100%) | 0 (0%) | 5 (100%) | 5 (100%) | 4 (80%) | 4 (80%) | 5 (100%) | 5 (100%) |
ESR | 14 (35%) | 0 (0%) | 0 (0%) | 1 (20%) | 3 (60%) | 2 (40%) | 3 (60%) | 0 (0%) | 5 (100%) |
CRP | 33 (82.5%) | 5 (0%) | 0 (0%) | 5 (100% | 5 (100%) | 5 (100%) | 3 (60%) | 5 (100%) | 5 (100%) |
LFT | 31 (77.5%) | 4 (80%) | 0 (0%) | 5 (100%) | 3 (60%) | 5 (100%) | 4 (80%) | 5 (100%) | 5 (100%) |
Bicarbonate | 10 (25%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 5 (100%) | 5 (100%) |
Procalcitonin | 0 (%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Total N (%) | MDFT Centre 1 N | MDFT Centre 2 N | MDFT Centre 3 N | MDFT Centre 4 N | MDFT Centre 5 N | MDFT Centre 6 N | MDFT Centre 7 N | MDFT Centre 8 N | |
---|---|---|---|---|---|---|---|---|---|
FBC | 226 (19%) | 72 | 0 | 12 | 27 | 24 | 12 | 28 | 51 |
eGFR | 161 (13.4%) | 81 | 0 | 14 | 28 | 24 | 14 | 0 | 0 |
U&E profile | 241 (20.1%) | 77 | 0 | 14 | 28 | 24 | 15 | 34 | 49 |
ESR | 56 (4.6%) | 0 | 0 | 3 | 19 | 0 | 2 | 0 | 32 |
CRP | 234 (19.5%) | 72 | 0 | 13 | 28 | 22 | 14 | 36 | 49 |
LFT | 232 (19.3%) | 72 | 0 | 14 | 27 | 24 | 14 | 36 | 45 |
Bicarbonate | 49 (4.1%) | 0 | 0 | 0 | 0 | 0 | 0 | 36 | 13 |
Procalcitonin | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Total tests | 1199 | 374 | 0 | 70 | 157 | 118 | 71 | 170 | 239 |
Total N (%) | MDFT Centre 1 N (%) | MDFT Centre 2 N (%) | MDFT Centre 3 N (%) | MDFT Centre 4 N (%) | MDFT Centre 5 N (%) | MDFT Centre 6 N (%) | MDFT Centre 7 N (%) | MDFT Centre 8 N (%) | |
---|---|---|---|---|---|---|---|---|---|
Wound swab for microscopy culture and sensitivity | 29 (72.5%) | 5 (100%) | 2 (40%) | 5 (100%) | 5 (100%) | 1 (20%) | 1 (20%) | 5 (100%) | 5 (100%) |
Tissue sample for microscopy culture and sensitivity | 14 (35%) | 1 (20%) | 0 (0%) | 0 (0%) | 3 (60%) | 4 (80%) | 2 (40%) | 0 (0%) | 4 (80%) |
Fluid aspirate for microscopy culture and sensitivity | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Bone sample for microscopy culture and sensitivity | 8 (20%) | 3 (60%) | 0 (0%) | 0 (0%) | 1 (20%) | 2 (40%) | 0 (%) | 2 (40%) | 0 (0%) |
Bone sample for histological examination | 1 (2.5%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (20%) |
Thermographic scan of the foot with DFO | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Clinician assessment | 40 (100%) | 5 (100%) | 5 (100%) | 5 (100%) | 5 (100%) | 5 (100%) | 5 (100%) | 5 (100%) | 5 (100%) |
Total N (%) | MDFT Centre 1 | MDFT Centre 2 | MDFT Centre 3 | MDFT Centre 4 | MDFT Centre 5 | MDFT Centre 6 | MDFT Centre 7 | MDFT Centre 8 | |
---|---|---|---|---|---|---|---|---|---|
Wound swab for microscopy culture and sensitivity | 88 (17.5%) | 31 | 3 | 5 | 11 | 0 | 0 | 6 | 32 |
Tissue sample for microscopy culture and sensitivity | 8 (1.6%) | 2 | 0 | 0 | 3 | 2 | 0 | 0 | 1 |
Fluid aspirate for microscopy culture and sensitivity | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Bone sample for microscopy culture and sensitivity | 8 (1.6%) | 3 | 0 | 0 | 1 | 2 | 0 | 2 | 0 |
Bone sample for histological examination | 1 (0.2%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Thermographic scan of the foot with DFO | 0 (0%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Clinician assessment | 396 (78.8%) | 106 | 17 | 40 | 67 | 33 | 20 | 60 | 53 |
Total | 501 | 143 | 20 | 45 | 82 | 36 | 20 | 69 | 87 |
Outcome | Total N (%) | MDFT Centre 1 | MDFT Centre 2 | MDFT Centre 3 | MDFT Centre 4 | MDFT Centre 5 | MDFT Centre 6 | MDFT Centre 7 | MDFT Centre 8 |
---|---|---|---|---|---|---|---|---|---|
Systemic antibiotics continued | 12 (30%) | 1 (20%) | 2 (40%) | 0 (0%) | 1 (20%) | 1 (20%) | 2 (40%) | 3 (60%) | 2 (40%) |
Systemic antibiotics stopped | 28 (70%) | 4 (80%) | 3 (60%) | 5 (100%) | 4 (80%) | 4 (80%) | 3 (60%) | 2 (40%) | 3 (60%) |
Quiescence of DFO | 27 (67.5%) | 5 (100%) | 2 (40%) | 5 (100%) | 4 (80%) | 4 (80%) | 2 (40%) | 2 (40%) | 3 (60%) |
No recurrence of DFO | 21 (52.5%) | 4 (80%) | 4 (80%) | 4 (80%) | 4 (80%) | 0 (0%) | 1 (20%) | 3 (60%) | 1 (20%) |
Surgery debridement only | 6 (15%) | 1 (20%) | 0 (0%) | 0 (0%) | 1 (20%) | 4 (80%) | 0 (0%) | 0 (0%) | 0 (0%) |
Surgery minor amputation | 12 (30%) | 2 (40%) | 0 (0%) | 1 (20%) | 1 (20%) | 3 (60%) | 0 (0%) | 2 (40%) | 3 (60%) |
Surgery major amputation | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Surgery with biological agent impregnated with antibiotics | 3 (7.5%) | 1 (20%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 2 (40%) |
Death due to DFO | 0 (0%) | 0 (0%) | 0 (0%) | 0 (%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Antibiotic(s) and Mode of Delivery | Patients (n = 40) | Systemic Antibiotics Continued | Systemic Antibiotics Stopped | Quiescence of DFO | No Recurrence of DFO | Surgery Debridement Only | Surgery Minor Amputation | Surgery Major Amputation | Surgery with Biological Agent Impregnated with Antibiotics | Death |
---|---|---|---|---|---|---|---|---|---|---|
Ceftriaxone IV | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
Ciprofloxacin oral | 2 | 0 | 2 | 1 | 1 | 1 | 0 | 0 | 0 | 0 |
Clindamycin oral | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 |
Clindamycin and ciprofloxacin oral | 9 | 2 | 7 | 6 | 5 | 0 | 3 | 0 | 0 | 0 |
Clindamycin and meropenem IV | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 0 |
Co-Amoxiclav oral | 2 | 2 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
Co-Amoxiclav IV | 3 | 0 | 2 | 2 | 0 | 3 | 2 | 0 | 0 | 0 |
Co-Amoxiclav and amoxicillin oral | 4 | 3 | 2 | 1 | 1 | 0 | 1 | 0 | 0 | 0 |
Co-Trimoxazole IV | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Doxycycline oral | 1 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 |
Ertapenem and metronidazole IV | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
Ertapenem and clindamycin IV | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
Flucloxacillin oral | 3 | 1 | 2 | 2 | 3 | 0 | 1 | 0 | 0 | 0 |
Flucloxacillin and fusidic acid oral | 3 | 0 | 3 | 3 | 3 | 0 | 1 | 0 | 0 | 0 |
Flucloxacillin and metronidazole IV | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 |
Linezolid oral | 1 | 0 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
Piperacillin/tazobactam IV | 2 | 1 | 1 | 2 | 1 | 0 | 0 | 0 | 0 | 0 |
Teicoplanin IV | 3 | 1 | 2 | 3 | 1 | 1 | 1 | 0 | 1 | 0 |
TOTAL | 40 | 12 (30%) | 28 (70%) | 27 (67.5%) | 21 (52.5%) | 6 (15%) | 12 (30%) | 0 (%) | 3 (7.5%) | 0 (0%) |
Total N (%) | MDFT Centre 1 N (%) | MDFT Centre 2 N (%) | MDFT Centre 3 N (%) | MDFT Centre 4 N (%) | MDFT Centre 5 N (%) | MDFT Centre 6 N (%) | MDFT Centre 7 N (%) | MDFT Centre 8 N (%) | |
---|---|---|---|---|---|---|---|---|---|
Mild allergic reaction (sensitivity) to antibiotic(s) | 5 (12.5%) | 0 (%) | 1 (20%) | 1 (20%) | 0 (0%) | 0 (0%) | 0 (0%) | 2 (40%) | 1 (20%) |
Severe allergic reaction (anaphylaxis) to antibiotic(s) | 0 (0%) | 0 (0%) | 0 (0%) | 0(%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (%) |
Acute kidney injury (AKI) | 4 (10%) | 1 (20%) | 0 (0%) | 1 (20%) | 1 (20%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (20%) |
Abnormal liver test | 6 (15%) | 2 (40%) | 0 (0%) | 2 (40%) | 1 (20%) | 0 (0%) | 1 (20%) | 0 (0% | 0 (0%) |
Clostridium difficile | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Total | 15 | 3 | 1 | 4 | 2 | 0 | 1 | 2 | 1 |
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Uddin, A.; Russell, D.A.; Game, F.; Santos, D.; Siddle, H.J. Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review. J. Clin. Med. 2024, 13, 3083. https://doi.org/10.3390/jcm13113083
Uddin A, Russell DA, Game F, Santos D, Siddle HJ. Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review. Journal of Clinical Medicine. 2024; 13(11):3083. https://doi.org/10.3390/jcm13113083
Chicago/Turabian StyleUddin, Akram, David A. Russell, Fran Game, Derek Santos, and Heidi J. Siddle. 2024. "Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review" Journal of Clinical Medicine 13, no. 11: 3083. https://doi.org/10.3390/jcm13113083
APA StyleUddin, A., Russell, D. A., Game, F., Santos, D., & Siddle, H. J. (2024). Variation in Systemic Antibiotic Treatment for Diabetic Foot Osteomyelitis in England and Wales: A Multi-Centre Case Review. Journal of Clinical Medicine, 13(11), 3083. https://doi.org/10.3390/jcm13113083