High Risk Foot Service, Liverpool Hospital, South Western Sydney LHD, Liverpool, Sydney, NSW, 2170, Australia.
South West Sydney Limb Preservation and Wound Research Academic Unit, South Western Sydney LHD, Liverpool, Sydney, NSW, 2170, Australia.
J Foot Ankle Res. 2021 Jan 28;14(1):10. doi: 10.1186/s13047-021-00448-w.
To utilise the 2019 International Working Group on the Diabetic Foot (IWGDF) - diabetic foot infection (DFI) guidelines as an audit tool for clinical practice in patients with diabetes attending a High-Risk Foot Service.
Data from 93 consecutive patients were collected over a 19-month period in patients attending a High-Risk Foot Service. The diagnosis and management of each patient in the sample were compared against the 2019 IWGDF DFI guidelines, grouped into four categories: Diagnosis, Microbiology, Treatment of soft tissue infection, and Surgical treatment and osteomyelitis. Deficits in performance were recorded using the recommendations as a benchmark standard.
There were 109 DFI events. Nineteen (63%) of the recommendations were met, 7 (24%) were partially met, and four (13%) recommendations were not met. Fourteen of the sample had no documented requests for full blood counts. Tissue was obtained for culture in 32 (29%) of the sample. No percutaneous bone biopsies were performed. Only 13 (28%) patients had intraoperative bone specimens sent for culture and sensitivities, with no bone specimens sent for histopathology. Modification of antibiotic therapy following available culture results was low, occurring in 12 out of 63 possible occasions (19%). The duration of antibiotic regimens in PEDIS 2 infections and osteomyelitis was greater than that recommended.
Utilising the IWGDF DFI guidelines to benchmark clinical practice is a useful tool to identify gaps in clinical performance or service delivery and may help to improve patient care.
利用 2019 年国际糖尿病足工作组（IWGDF）-糖尿病足感染（DFI）指南作为审计工具，评估在高风险足部服务中就诊的糖尿病患者的临床实践。
在 19 个月的时间里，连续收集了 93 例高风险足部服务患者的数据。将样本中每位患者的诊断和治疗与 2019 年 IWGDF DFI 指南进行比较，分为四类：诊断、微生物学、软组织感染治疗和手术治疗和骨髓炎。使用建议作为基准标准记录性能缺陷。
共有 109 例 DFI 事件。19 项（63%）建议得到满足，7 项（24%）部分满足，4 项（13%）建议未满足。样本中有 14 例没有记录全血细胞计数的请求。样本中仅 32 例（29%）获得了组织培养物。未进行经皮骨活检。只有 13 例（28%）患者在术中送检了骨标本进行培养和药敏试验，没有骨标本送检进行组织病理学检查。根据可用的培养结果修改抗生素治疗的情况很少，在 63 种可能的情况下只有 12 种（19%）。PEDIS 2 感染和骨髓炎中抗生素方案的持续时间长于推荐的时间。
利用 IWGDF DFI 指南作为基准来评估临床实践是一种有用的工具，可以识别临床性能或服务提供方面的差距，并可能有助于改善患者的护理。
