Methods: This study was a retrospective observational analysis of patients with DFI initially managed in the UCH ED from January to December 2013. Data collected included wound characteristics, empiric antibiotics in the ED, previous antibiotics within 30 days, culture/sensitivity results, discharge antibiotics, duration of therapy, and return to the ED within 30 days. Appropriateness of antibiotic therapy was based on adherence to IDSA guidelines.
Results: A total of 142 patients with diabetic foot ulcers were evaluated; 95% had active infections and 76% were rated as moderate or severe based on IDSA guidelines. Empiric antibiotic were begun in the ED in 89% of patients but only 39% of regimens were appropriate per IDSA guidelines. The most common reason for inappropriate antibiotics was lack of adherence to guideline recommendations regarding inclusion of antibiotics with Pseudomonas coverage: 42% of regimens inadequately covered Pseudomonas in patients with risk factors, and 16% of patients were covered for Pseudomonas without risk factors. Similarly, 6% of regimens inadequately covered methicillin-resistant S. aureus (MRSA) despite risk factors while 37% of patients had no risk factors but were treated for MRSA. Regarding duration of therapy, 51% of patients had inappropriate treatment duration based on severity of DFI; 77% of these were inappropriate due to excessively long durations. Readmissions to the ED within 30 days of previous discharge occurred in 27 patients (19%); 33% of these (9 patients) were due to recurrent DFI and 22% (2 patients) were associated with inappropriate treatment.
Conclusion: Adherence to the 2012 IDSA guidelines for the empiric treatment of DFI in the ED is poor. Improving empiric antibiotic selection in the ED is an important target for future education and practice efforts.
D. N. Fish, None
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