Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia.
Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.
J Foot Ankle Res. 2022 Mar 2;15(1):18. doi: 10.1186/s13047-022-00523-w.
There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection.
Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis.
29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways.
Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection.
目前缺乏高质量的证据来指导糖尿病相关足部感染的最佳管理，特别是在严重糖尿病相关足部感染和糖尿病相关骨髓炎的情况下。本研究调查了外科医生对严重糖尿病相关足部感染的首选治疗方法的意见。
澳大利亚和新西兰的血管和骨科外科医生受邀通过电子邮件完成在线调查。该调查包括关于糖尿病相关足部感染临床管理的多项选择和开放式问题。使用非参数统计检验比较血管外科医生和骨科外科医生的回答。使用归纳内容分析检查开放文本的回复。
29 名血管外科医生和 20 名骨科外科医生完成了调查。三分之一（28.6%）的人使用最佳实践指南来协助决定足部感染的管理。确定需要改进指南的领域包括针对现有治疗方法的适应证提供更具体的建议、更多关于非手术患者管理的建议以及关于在卫生服务资源有限的地区如何调整管理的建议。骨探测试验和磁共振成像（MRI）是诊断骨髓炎的首选方法。大约一半（51.2%）的受访者表示哌拉西林/他唑巴坦是治疗严重糖尿病相关足部感染的经验性治疗的首选抗生素。清创术后负压伤口治疗是管理伤口的最常见方法。所有血管外科医生（100%）根据缺血严重程度做出血运重建决策，而大多数骨科外科医生（66.7%）可能会请血管外科医生做出血运重建决策。血管外科医生更喜欢使用伤口拭子，而骨科外科医生则更喜欢使用组织或骨活检来确定抗生素的选择。受访者认为专家之间的管理决策存在一定差异，并支持开展随机对照试验以检验不同的管理途径。
大多数血管外科医生和骨科外科医生不使用最佳实践指南来协助决定糖尿病相关足部感染的治疗方法。血管外科医生和骨科外科医生似乎对确定抗生素选择的伤口采样有不同的偏好。需要更高质量的证据来阐明管理糖尿病相关足部感染的最佳实践。
