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Malone M, Bergamin E, Hayashi K, Schwarzer S, Dickson HG, Lau N, Lavery LA, Commons RJ. Clinical outcomes in people with diabetes-related foot infections: Analysis from a limb preservation service infection database. J Foot Ankle Res 2024; 17:e12040. [PMID: 38982577 DOI: 10.1002/jfa2.12040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Diabetes-related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes-related foot infections. METHODS A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST-DFI) and osteomyelitis (OM) using chi-square tests. RESULTS Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST-DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST-DFI (OM = 140, 71% vs. SST-DFI = 58, 29%, p < 0.00001). In patients with SST-DFI a greater number of infection failures were observed in the presence of peripheral arterial disease (PAD) compared to the patients without PAD (failure occurred in 30% (31/103) of episodes with PAD and 12% (27/223) of episodes without PAD; p < 0.001). In contrast, the number of observed infection failures in OM episodes were similar in patients with and without PAD (failure occurred in 45% (57/128) of episodes with PAD and 55% (83/193) of episodes without PAD; p = 0.78). CONCLUSIONS This study provides important epidemiological data on the risk of poor outcomes for DFI and factors associated with poor outcomes in an Australian setting. It highlights the association of PAD and treatment failure, reinforcing the need for early intervention to improve PAD in patients with DFI. Future randomised trials should assess the benefits of revascularisation and surgery in people with DFI and particularly those with OM where outcomes are worse.
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Affiliation(s)
- Matthew Malone
- South West Sydney Limb Preservation and Wound Research, Sydney, New South Wales, Australia
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Emma Bergamin
- South West Sydney Limb Preservation and Wound Research, Sydney, New South Wales, Australia
- High Risk Foot Service, Liverpool Hospital, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Kenshin Hayashi
- High Risk Foot Service, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Saskia Schwarzer
- South West Sydney Limb Preservation and Wound Research, Sydney, New South Wales, Australia
- High Risk Foot Service, Liverpool Hospital, Sydney, New South Wales, Australia
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Hugh G Dickson
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
- Ambulatory Care and PIXI, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Namson Lau
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
- Department of Diabetes and Endocrinology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert J Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- General and Subspecialty Medicine, Grampians Health Ballarat, Ballarat, Victoria, Australia
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Su G, Yuan X, Yuan G, Sun Y, Zhang D, Liu W, Zhang J, Guo X. Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing. Front Endocrinol (Lausanne) 2024; 15:1441997. [PMID: 39175572 PMCID: PMC11339879 DOI: 10.3389/fendo.2024.1441997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024] Open
Abstract
Background Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Methods Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. Results and conclusions After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.
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Affiliation(s)
- Guanming Su
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- Department of Endocrinology, The Second Hospital of Shijiazhuang, Shijiazhuang, China
| | - Xiaoyong Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Geheng Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Yalan Sun
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Donghui Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Wei Liu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
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Shen D, Huang K, Guo Q, Ma G, Ding L. The Efficacy of Local Antibiotic Delivery Systems Therapy in the Management of Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2024:15347346241266062. [PMID: 39033388 DOI: 10.1177/15347346241266062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
PURPOSE We aim to evaluate the efficacy of local antibiotic delivery systems in patients with diabetic foot osteomyelitis (DFO). METHODS The Web of Science, PubMed, and Embase databases were searched for relevant publications until March 2024. All studies evaluating the efficacy of local antibiotic delivery systems in patients with DFO were included. We calculated pooled risk ratio (RR) with 95% CIs for binary outcomes and mean difference (MD) for continuous outcomes. The Cochrane's risk of bias tool and methodological index for non-randomized studies (MINORS) assessment were used to evaluate the quality of studies. RESULTS A total of 9 studies with 491 patients were included in this analysis. The overall healing rate in antibiotic group was 0.85 (95% CI: 0.67, 0.97). Healing rates were significantly higher in the antibiotic group compared to the control group (RR: 1.18, 95% CI: 1.01, 1.38). Furthermore, recurrence rates and amputation rates have no significantly difference between the antibiotic group and the control group (RR: 0.30, 95% CI: 0.04, 2.12 and RR: 0.22, 95% CI:0.03, 1.91), along with no significantly difference in healing time and hospital stays(MD: -7.87, 95% CI: -20.81, 5.07 and MD:-2.33, 95% CI:-5.17, 0.50). No obvious publication bias was observed in the funnel plot (Egger's test, P = .99). CONCLUSIONS Our meta-analysis found that diabetic foot osteomyelitis patients treated with local antibiotic delivery systems had better healing rates than the control group. However, no significant differences were found in healing time, recurrence, hospital stays, or amputation rates. Larger randomized controlled trials are necessary in the future.
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Affiliation(s)
- Di Shen
- Department of Orthopedic Trauma, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Kai Huang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Qiaofeng Guo
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Gouping Ma
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Liqing Ding
- Department of Endocrinology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Zhao Y, Jing L, Ma X, Li Y, Zhang J, Li C, Liu G, Dai J, Cao S. Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023. J Tissue Viability 2024:S0965-206X(24)00113-X. [PMID: 39038996 DOI: 10.1016/j.jtv.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/09/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUNDS Diabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas. PURPOSE This study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field. METHODS Relevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries. RESULTS A total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that "amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. "Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as "pressure ulcers", "burden", and "chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies. CONCLUSIONS The current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.
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Affiliation(s)
- Yanan Zhao
- School of Nursing, Capital Medical University, Beijing, China
| | - Liwei Jing
- School of Nursing, Capital Medical University, Beijing, China.
| | - Xin Ma
- Department of Othopaedics, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Sixth People's Hospital, Shanghai, China.
| | - Yangxi Li
- China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Chenyang Li
- School of Nursing, Capital Medical University, Beijing, China
| | - Guangtian Liu
- College of Nursing and Rehabilitation, North China University of Science and Tchnology, Hebei, China
| | - Jiaqi Dai
- School of Nursing, Capital Medical University, Beijing, China
| | - Shengxuan Cao
- Department of Othopaedics, Huashan Hospital, Fudan University, Shanghai, China
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Guo P, Tu Y, Liu R, Gao Z, Du M, Fu Y, Wang Y, Yan S, Shang X. Performance of risk prediction models for diabetic foot ulcer: a meta-analysis. PeerJ 2024; 12:e17770. [PMID: 39035162 PMCID: PMC11260075 DOI: 10.7717/peerj.17770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Background The number of prediction models for diabetic foot ulcer (DFU) risk is increasing, but their methodological quality and clinical applicability are uncertain. We conducted a systematic review to assess their performance. Methods We searched PubMed, Cochrane Library, and Embase databases up to 10 February 2024 and extracted relevant information from selected prediction models. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) checklist was used to assess bias risk and applicability. All statistical analyses were conducted in Stata 14.0. Results Initially, 13,562 studies were retrieved, leading to the inclusion of five development and five validation models from eight studies. DFU incidence ranged from 6% to 16.8%, with age and hemoglobin A1C (HbA1c) commonly used as predictive factors. All included studies had a high risk of bias, mainly due to disparities in population characteristics and methodology. In the meta-analysis, we observed area under the curve (AUC) values of 0.78 (95% CI [0.69-0.89]) for development models and 0.84 (95% CI [0.79-0.90]) for validation models. Conclusion DFU risk prediction models show good overall accuracy, but there is a risk of bias. Adherence to the PROBAST checklist is crucial for improving their clinical applicability.
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Affiliation(s)
- Panpan Guo
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yujie Tu
- The 154th Hospital, Xinyang, Henan, China
| | - Ruiyan Liu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Zihui Gao
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Mengyu Du
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yu Fu
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Ying Wang
- Department of Geriatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuxun Yan
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xin Shang
- Department of Endocrinology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
- School of First Clinical, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Guo H, Xiao K, Zheng Y, Zong J. Integrating bioinformatics and multiple machine learning to identify mitophagy-related targets for the diagnosis and treatment of diabetic foot ulcers: evidence from transcriptome analysis and drug docking. Front Mol Biosci 2024; 11:1420136. [PMID: 39044840 PMCID: PMC11263085 DOI: 10.3389/fmolb.2024.1420136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Background Diabetic foot ulcers are the most common and serious complication of diabetes mellitus, the high morbidity, mortality, and disability of which greatly diminish the quality of life of patients and impose a heavy socioeconomic burden. Thus, it is urgent to identify potential biomarkers and targeted drugs for diabetic foot ulcers. Methods In this study, we downloaded datasets related to diabetic foot ulcers from gene expression omnibus. Dysregulation of mitophagy-related genes was identified by differential analysis and weighted gene co-expression network analysis. Multiple machine algorithms were utilized to identify hub mitophagy-related genes, and a novel artificial neural network model for assisting in the diagnosis of diabetic foot ulcers was constructed based on their transcriptome expression patterns. Finally, potential drugs that can target hub mitophagy-related genes were identified using the Enrichr platform and molecular docking methods. Results In this study, we identified 702 differentially expressed genes related to diabetic foot ulcers, and enrichment analysis showed that these genes were associated with mitochondria and energy metabolism. Subsequently, we identified hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain as hub mitophagy-related genes of diabetic foot ulcers using multiple machine learning algorithms and validated their diagnostic performance in a validation cohort independent of the present study (The areas under roc curve of hexokinase-2, small ribosomal subunit protein us3, and l-lactate dehydrogenase A chain are 0.671, 0.870, and 0.739, respectively). Next, we constructed a novel artificial neural network model for the molecular diagnosis of diabetic foot ulcers, and the diagnostic performance of the training cohort and validation cohort was good, with areas under roc curve of 0.924 and 0.840, respectively. Finally, we identified retinoic acid and estradiol as promising anti-diabetic foot ulcers by targeting hexokinase-2 (-6.6 and -7.2 kcal/mol), small ribosomal subunit protein us3 (-7.5 and -8.3 kcal/mol), and l-lactate dehydrogenase A chain (-7.6 and -8.5 kcal/mol). Conclusion The present study identified hexokinase-2, small ribosomal subunit protein us3 and l-lactate dehydrogenase A chain, and emphasized their critical roles in the diagnosis and treatment of diabetic foot ulcers through multiple dimensions, providing promising diagnostic biomarkers and targeted drugs for diabetic foot ulcers.
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Affiliation(s)
- Hui Guo
- Department of Emergency, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Kui Xiao
- Department of Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yanhua Zheng
- Department of Critical Medicine, Wusong Hospital, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianchun Zong
- Department of Emergency, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Coşkun B, Ayhan M, Ulusoy S, Guner R. Bacterial Profile and Antimicrobial Resistance Patterns of Diabetic Foot Infections in a Major Research Hospital of Turkey. Antibiotics (Basel) 2024; 13:599. [PMID: 39061280 PMCID: PMC11274067 DOI: 10.3390/antibiotics13070599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Aim: Diabetic foot infection (DFI) occurs frequently in patients, followed up with diabetic foot ulcers (DFU). For this reason, antibiotic treatment is often used in patients followed with DFU. Inappropriate use of antibiotics and increasing antibiotic resistance threaten public health. We aimed to investigate the microbial spectrum and antimicrobial resistance patterns isolated from diabetic foot infections in Turkey and help clinicians to choose optimal antibiotics empirically. Materials and Methods: This study was planned as a retrospective, single-center, cross-sectional study. Two hundred sixty-two patients whose causative microorganism was isolated in culture of tissue between 1 January 2021 and 31 December 2022 were included in this study. Bacterial profile and antimicrobial resistance patterns were analyzed. Results: Four hundred thirty two isolates from 262 patients isolated in culture of tissue were evaluated. Of these microorganisms, 57.60% were Gram-negative, 41.20% were Gram-positive bacteria, and 1.2% were Candida spp. The most frequently detected Gram-positive microorganism was Staphylococcus spp. Gram-negative microorganisms were Escherichia coli (E. coli) and Pseudomonas aeruginosa (P. aeruginosa). Polymicrobial infections were observed in 40.5% of the patients. Methicillin-resistant Staphylococcus spp. rate was 51.3%, while extended-spectrum beta-lactamase (ESBL) resistance for E. coli was 66.7%. Conclusions: Due to increasing antibiotic resistance rates, treatment of common infections becomes more difficult. Knowledge of the microbiological profile and antibiotic resistance patterns of patients with DFIs is useful to guide empirical therapy.
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Affiliation(s)
- Belgin Coşkun
- Ankara Bilkent City Hospital, 06700 Ankara, Turkey; (M.A.); (S.U.); (R.G.)
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Morton KE, Coghill SH. Staphylococcus aureus Is the Predominant Pathogen in Hospitalised Patients with Diabetes-Related Foot Infections: An Australian Perspective. Antibiotics (Basel) 2024; 13:594. [PMID: 39061276 PMCID: PMC11273989 DOI: 10.3390/antibiotics13070594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes prevalence continues to increase worldwide, which has led to a rising incidence of diabetes-related foot infections (DFIs). There is significant local variation in the microbiology of DFIs, and Pseudomonas spp. is suggested to be more prevalent in subtropical climates. The aim of this study was to investigate the local microbiological findings in patients admitted to the hospital with DFIs. This retrospective study analysed data from all adult patients diagnosed with diabetes and admitted to the hospital for the treatment of a DFI between 1 January 2021 and 31 December 2022. Both superficial wound swabs and tissue cultures were included. The Infectious Diseases Society of America classification system was used to categorise the severity of the DFI. Patient characteristics and demographics were analysed using descriptive statistics. One hundred fifty-one episodes of care were included. Most of the DFIs were classified as moderate infections 101/151 (67%). The most commonly isolated microorganism was Staphylococcus aureus (33%) followed by normal skin flora (11%) and β-haemolytic streptococci (7%). P. aeruginosa was isolated more commonly in those with chronic DFIs (10%) compared to those with acute DFIs (2%). Despite the frequent identification of S. aureus, 83% of patients received an antipseudomonal antibiotic. The introduction of multidisciplinary DFI rounds should be considered.
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Affiliation(s)
- Kate E. Morton
- Pharmacy Department, Lismore Base Hospital, Lismore, NSW 2480, Australia
| | - Sarah H. Coghill
- Infectious Diseases Department, Lismore Base Hospital, Lismore, NSW 2480, Australia
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Veve MP, Patel N. Reply to Lau et al Re: "Antipseudomonal Antibiotics in Diabetic Foot Infections: A Practical Perspective From a Community Hospital". Open Forum Infect Dis 2024; 11:ofae259. [PMID: 38933741 PMCID: PMC11200184 DOI: 10.1093/ofid/ofae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Michael P Veve
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Nimish Patel
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, La Jolla, California, USA
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Liu E, Hu X, Zhang W, Xiao W, Shen Y, Luo Y, Zheng Z, Zhou P, He Y, Que H. Efficacy and safety of ultrasound-assisted wound debridement in the treatment of diabetic foot ulcers: a systematic review and meta-analysis of 11 randomized controlled trials. Front Endocrinol (Lausanne) 2024; 15:1393251. [PMID: 38752180 PMCID: PMC11094243 DOI: 10.3389/fendo.2024.1393251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Objective Research data suggests that ultrasound-assisted wound debridement (UAWD) can effectively promote the healing of diabetic foot ulcers (DFU). However, existing research is not consistent with this viewpoint. Therefore, we conducted this study to investigate the effect of UAWD on the healing of diabetic foot ulcers. Methods From the establishment of the database to January 2024, we searched 8 databases to study the effectiveness and safety of UAWD in the treatment of DFU. Two authors independently screened the qualifications of the articles, while two authors extracted relevant data. Statistical analysis was conducted using Review Manager 5.4 and STATA 18.0 software. Results A total of 11 randomized controlled studies were included, with 6 countries and 696 participants participating. Our findings showed that UAWD was associated with a significant benefit in healing rate (OR = 2.60, 95% CI: [1.67, 4.03], P < 0.0001, I2 = 25%), wound healing time (MD = -11.94, 95% CI: [-23.65, -0.23], P = 0.05, I2 = 99%), percentage reduction in wound size (MD = 14.2, 95% CI: [10.8, 17.6], P = 0.47, I2 = 32%), effectiveness of treatment (OR = 10.3, 95% CI: [4.68, 22.66], P < 0.00001, I2 = 0%). Moreover, UAWD did not cause any significant adverse reactions. However, there was no obvious difference in wound blood perfusion (MD = 0.25, 95% CI: [-0.01, 0.52], P = 0.06, I2 = 90%), transcutaneous oxygen partial pressure (MD = 14.34, 95% CI: [-10.03, 38.71], P = 0.25, I2 = 98%). Conclusion UAWD can significantly improve wound healing rate, shorten wound healing time, accelerate wound area reduction, and improve clinical treatment effectiveness without significant adverse reactions. Although there is no significant difference in transcutaneous oxygen pressure and wound blood flow perfusion between UAWD and SWC. So we look forward to more scientifically blinded, placebo-controlled, high-quality studies in the future, to enable researchers to obtain more complete and accurate analytical data, in order to improve the scientific and credibility of the evidence. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024501198.
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Affiliation(s)
- Erhao Liu
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojie Hu
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenke Zhang
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Xiao
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiting Shen
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Luo
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zeyu Zheng
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pengfei Zhou
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Youcheng He
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huafa Que
- Department of Traditional Chinese Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, Monteiro-Soares M, Senneville E, Schaper NC. The unique multidisciplinarity of diabetes-related foot disease. Diabetes Metab Res Rev 2024; 40:e3804. [PMID: 38616492 DOI: 10.1002/dmrr.3804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Few diseases globally require treatment from so many different disciplines as diabetes-related foot disease. At least 25 different professionals may be involved: casting technicians, dermatologists, diabetes (educator) nurses, diabetologists, dieticians, endocrinologists, general practitioners, human movement scientists, infectious diseases experts, microbiologists, nuclear medicine physicians, orthopaedic surgeons, orthotists, pedorthists, physical therapists, plastic surgeons, podiatric surgeons, podiatrists, prosthetists, psychologists, radiologists, social workers, tissue viability physicians, vascular surgeons, and wound care nurses. A shared vocabulary and shared treatment goals and recommendations are then essential. The International Working Group on the Diabetic Foot (IWGDF) has produced guidelines and supporting documents to stimulate and support shared and multidisciplinary evidence-based treatment in diabetes-related foot disease. In this special virtual issue of Diabetes/Metabolism Research and Reviews, all 21 documents of the 2023 update of the IWGDF Guidelines are bundled, added with a further 6 reviews from multidisciplinary experts to drive future research and clinical innovations, based on their contributions to the International Symposium on the Diabetic Foot. We hope the readers will enjoy this special virtual issue, and widely implement the knowledge shared here in their daily clinical practice and research endeavours with the goal to improve the care for people with diabetes-related foot disease.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, the Netherlands
| | - Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Fran Game
- Research and Development Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal
- Cross I&D, Lisbon, Portugal
- MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@ CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal
| | - Eric Senneville
- Department of Infectious Diseases Gustave Dron Hospital, Univ-lille, Tourcoing, France
| | - Nicolaas C Schaper
- Division Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, the Netherlands
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12
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Hulshof CM, Page M, van Baal SG, Bus SA, Fernando ME, van Gemert-Pijnen L, Kappert KDR, Lucadou-Wells S, Najafi B, van Netten JJ, Lazzarini PA. The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies. SENSORS (BASEL, SWITZERLAND) 2024; 24:2411. [PMID: 38676030 PMCID: PMC11054765 DOI: 10.3390/s24082411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.
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Affiliation(s)
- Chantal M. Hulshof
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Madelyn Page
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | | | - Sicco A. Bus
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands
| | - Malindu E. Fernando
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
- Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA 90242, USA
- Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- Department of Vascular and Endovascular Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | | | - Scott Lucadou-Wells
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD 4032, Australia
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jaap J. van Netten
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Peter A. Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD 4032, Australia
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13
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Burillo A, Pulido-Pérez A, Bouza E. Current challenges in acute bacterial skin infection management. Curr Opin Infect Dis 2024; 37:71-79. [PMID: 38179868 DOI: 10.1097/qco.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW There are aspects of skin and soft tissue infections (SSTIs) that remain unresolved, such as current numbers, classification criteria, how best to define severity and predict the outcome, what diagnostic tests to perform, what new treatment options are available, or what the duration of antibiotic treatment should be. We have reviewed the literature over the last 18 months to clarify these issues and provide our opinion. RECENT FINDINGS SSTIs are common and among the top 10 most frequent infections worldwide. They represent a burden on the healthcare system and have a major impact on the quality of life of patients. Regarding classification, the Infectious Diseases Society of America (IDSA) provides a practical guide that distinguishes between uncomplicated and complicated infections, acute and chronic wound infections, and necrotising and nonnecrotizing infections based on skin extension and tissue necrosis. With new microbiological and imaging diagnostic techniques, SSTIs can now be better diagnosed. New PCR techniques are available, and mass spectrometry can be applied to samples collected in liquid transport media. Moreover, new treatment methods such as photodynamic therapy, reactive oxygen, and phages are emerging. SSTI patients can be treated with shorter antibiotic courses if they receive an active drug with good tissue penetration. Antibiotic treatment in necrotizing infections can be shortened to 48 h after the last debridement. SUMMARY SSTIs remain a challenge regarding rapid and accurate diagnosis and clinical management.
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Affiliation(s)
- Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute, (IiSGM)
| | - Ana Pulido-Pérez
- Gregorio Marañón Health Research Institute, (IiSGM)
- Department of Dermatology, Hospital General Universitario Gregorio Marañón
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute, (IiSGM)
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
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14
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Flores-Escobar S, López-Moral M, García-Madrid M, Álvaro-Afonso FJ, Tardáguila-García A, Lázaro-Martínez JL. Diagnostic Performance of Atherogenic Index of Plasma for Predicting Diabetic Foot Osteomyelitis with Peripheral Artery Disease. J Clin Med 2024; 13:1934. [PMID: 38610699 PMCID: PMC11012599 DOI: 10.3390/jcm13071934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study aims to assess the atherogenic index of plasma (AIP) diagnostic value in detecting diabetic foot osteomyelitis (DFO) among patients with diabetic foot ulcers (DFUs). Methods: A prospective cohort study was conducted on 80 patients with DFUs and suspected DFO between January 2022 and December 2023. The primary outcome measures included the diagnosis of DFO, determined by positive microbiological analysis results from bone samples and its correlation with the AIP. Receiver operating characteristic (ROC) curves were utilized to select the optimal diagnostic cut-off points for AIP and post hoc analysis was performed to evaluate the difference in the AIP for diagnosing DFO in patients with and without peripheral arterial disease (PAD). Results: The diagnostic potential for DFO in PAD patients of AIP-1 (Log TC/HDL) showed an AUC of 0.914 (p < 0.001 [0.832-0.996]), leading to a sensitivity of 83% and a specificity of 85%. By contrast, AIP-2 (Log TG/HDL) demonstrated a slightly lower AUC of 0.841 (p < 0.001 [0.716-0.967]), leading to a sensitivity of 76% and a specificity of 74%. Conclusions: The AIP tool, with its ideal blend of sensitivity and specificity, aids in predicting DFO effectively. Therefore, clinicians should consider using AIP for patients suffering from PAD and associated DFO.
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Affiliation(s)
- Sebastián Flores-Escobar
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Francisco J. Álvaro-Afonso
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Aroa Tardáguila-García
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (S.F.-E.); (M.G.-M.); (F.J.Á.-A.); (A.T.-G.); (J.L.L.-M.)
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt CA, Boyko EJ, Conte MS, Humphries M, Kirksey L, McGinigle KC, Nikol S, Nordanstig J, Rowe V, Russell D, van den Berg JC, Venermo M, Schaper N. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev 2024; 40:e3686. [PMID: 37726988 DOI: 10.1002/dmrr.3686] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Diabetes related foot complications have become a major cause of morbidity and are implicated in most major and minor amputations globally. Approximately 50% of people with diabetes and a foot ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of adverse limb and cardiovascular events. The International Working Group on the Diabetic Foot (IWGDF) has published evidence based guidelines on the management and prevention of diabetes related foot complications since 1999. This guideline is an update of the 2019 IWGDF guideline on the diagnosis, prognosis and management of peripheral artery disease in people with diabetes mellitus and a foot ulcer. For this guideline the IWGDF, the European Society for Vascular Surgery and the Society for Vascular Surgery decided to collaborate to develop a consistent suite of recommendations relevant to clinicians in all countries. This guideline is based on three new systematic reviews. Using the Grading of Recommendations, Assessment, Development, and Evaluation framework clinically relevant questions were formulated, and the literature was systematically reviewed. After assessing the certainty of the evidence, recommendations were formulated which were weighed against the balance of benefits and harms, patient values, feasibility, acceptability, equity, resources required, and when available, costs. Through this process five recommendations were developed for diagnosing PAD in a person with diabetes, with and without a foot ulcer or gangrene. Five recommendations were developed for prognosis relating to estimating likelihood of healing and amputation outcomes in a person with diabetes and a foot ulcer or gangrene. Fifteen recommendations were developed related to PAD treatment encompassing prioritisation of people for revascularisation, the choice of a procedure and post-surgical care. In addition, the Writing Committee has highlighted key research questions where current evidence is lacking. The Writing Committee believes that following these recommendations will help healthcare professionals to provide better care and will reduce the burden of diabetes related foot complications.
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Affiliation(s)
- Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide and Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Vivienne Chuter
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | | | - Robert Hinchliffe
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | | | - Michael S Conte
- San Francisco Medical Centre, University of California, San Francisco, California, USA
| | | | | | | | - Sigrid Nikol
- Clinical and Interventional Angiology, Asklepios Klinik, St Georg, Hamburg, Germany
| | | | - Vincent Rowe
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Jos C van den Berg
- CENTRO VASCOLARE TICINO Ospedale Regionale di Lugano, sede Civico and Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie Inselspital, Universitätsspital, Bern, Switzerland
| | - Maarit Venermo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Nicolaas Schaper
- Division of Endocrinology, Department Internal Medicine, MUMC+, Maastricht, The Netherlands
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Bus SA, Armstrong DG, Crews RT, Gooday C, Jarl G, Kirketerp-Moller K, Viswanathan V, Lazzarini PA. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev 2024; 40:e3647. [PMID: 37226568 DOI: 10.1002/dmrr.3647] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
AIMS Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on offloading interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline. MATERIALS AND METHODS We followed the GRADE approach by devising clinical questions and important outcomes in the PICO (Patient-Intervention-Control-Outcome) format, undertaking a systematic review and meta-analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement items including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability. RESULTS For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non-removable knee-high offloading device as the first-choice offloading intervention. If contraindications or patient intolerance to non-removable offloading exist, consider using a removable knee-high or ankle-high offloading device as the second-choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third-choice offloading intervention. If such a non-surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non-plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice. CONCLUSION These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes-related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.
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Affiliation(s)
- Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Science, Program Rehabilitation & Development, Amsterdam, Netherlands
| | - David G Armstrong
- Department of Surgery, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of University of Southern California (USC), Los Angeles, California, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University, North Chicago, Illinois, USA
| | - Catherine Gooday
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Gustav Jarl
- Faculty of Medicine and Health, Department of Prosthetics and Orthotics, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Klaus Kirketerp-Moller
- Copenhagen Wound Healing Center, Bispebjerg University Hospital, Copenhagen, Denmark
- Steno Diabetes Center, Copenhagen, Denmark
| | | | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
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17
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Wukich DK, Schaper NC, Gooday C, Bal A, Bem R, Chhabra A, Hastings M, Holmes C, Petrova NL, Santini Araujo MG, Senneville E, Raspovic KM. Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023). Diabetes Metab Res Rev 2024; 40:e3646. [PMID: 37218537 DOI: 10.1002/dmrr.3646] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.
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Affiliation(s)
- Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicolaas C Schaper
- Division of Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, The Netherlands
| | - Catherine Gooday
- Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Arun Bal
- Secretary, International Association of Diabetic Foot Surgeons, Mumbai, India
| | - Robert Bem
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mary Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Crystal Holmes
- The Division of Metabolism, Endocrinology and Diabetes, The University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nina L Petrova
- Department of Diabetes, Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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18
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Hon K, Nobels F, Senneville É, Uckay I, Maas M, Fitridge R. Assessment and management of diabetes-related foot infection according to the new International Working Group on the Diabetic Foot guidelines 2023-Multidisciplinary grand rounds. Diabetes Metab Res Rev 2024; 40:e3737. [PMID: 37855302 DOI: 10.1002/dmrr.3737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
Diabetes-related foot disease is a serious and common complication for people with diabetes mellitus. The gold standard care for a person with diabetes-related foot disease is the involvement of a multidisciplinary foot team engaged in evidence-based care. To date, there are seven International Working Group on the Diabetic Foot (IWGDF) guidelines published to assist healthcare providers in managing diabetes-related foot disease around the world. This review discusses the acute management of diabetes-related foot infection with insights from experts of various specialities (internal medicine, infectious disease, vascular surgery, radiology) with a discussion on the implementation of IWGDF guidelines in real life practice and the challenges that healthcare providers may face.
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Affiliation(s)
- Kay Hon
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Frank Nobels
- Department of Internal Medicine-Endocrinology, Onze-Lieve-Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Éric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
- Univ-Lille, Lille, France
| | - Ilker Uckay
- Balgrist University Hospital, Zurich, Switzerland
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
| | - Robert Fitridge
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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19
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van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, Monteiro-Soares M, Senneville E, Schaper NC. The International Working Group on the Diabetic Foot: Stories and Numbers Behind Three Decades of Evidence-Based Guidelines for the Management of Diabetes-Related Foot Disease. Diabetes Ther 2024; 15:19-31. [PMID: 37971638 PMCID: PMC10786793 DOI: 10.1007/s13300-023-01510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Foot disease is a devastating complication of diabetes. For almost 3 decades, the mission of the International Working Group on the Diabetic Foot (IWGDF) is to produce evidence-based guidelines to inform health care providers worldwide on strategies for the prevention and management of diabetes-related foot disease. In this publication, we aim to better inform the reader about 'the story behind' the IWGDF Guidelines and thus facilitate improved uptake of the recommendations described in the guidelines. The first IWGDF Guidelines were published in 1999, and these have been successfully updated every 4 years since. With each update, IWGDF has improved the methodological rigour and extended the topics covered. This has been possible thanks to the involvement of > 100 experts from > 60 countries, all voluntarily dedicating their time. We estimate that the 2023 update of the IWGDF Guidelines required a total 10 years of full-time work, which would have cost 2 million euros if the voluntary work had been financially compensated. The IWGDF Guidelines are not only published in English but also translated to support local implementation. Currently available translations serve 2.9 billion people globally in their native language. As an independent and multidisciplinary organisation, IWGDF hopes that the 2023 update will continue to stimulate clinicians from all different disciplines to deliver the best care possible for these patients, will motivate researchers to undertake the high-quality trials needed to deliver the new evidence to advance the field further, and collectively will support people with diabetes-related foot disease to minimize their disease burdens.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Program Rehabilitation, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Program Rehabilitation, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide, Vascular and Endovascular Surgery Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Fran Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Matilde Monteiro-Soares
- Portuguese Red Cross School of Health-Lisbon, Lisbon, Portugal
- MEDCIDS-Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal
- RISE@ CINTESIS, Faculty of Medicine, Oporto University, Porto, Portugal
| | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, Tourcoing, France
- Univ-Lille, Lille, France
| | - Nicolaas C Schaper
- Division of Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, The Netherlands
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