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The online version of this article (https://doi.org/10.1186/s13047-018-0256-3) contains supplementary material, which is available to authorized users.
Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand.
A cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians’ management practices of patients with DFIs.
Approximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely.
Patients with DFIs represent a significant proportion of an ID clinician’s caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.
Additional file 1: Questionnaire. (DOCX 34 kb)13047_2018_256_MOESM1_ESM.docx
Barr E, Magliano D, Zimmet P, Polkinghorne K, Atkins R, Dunstan D, Murray S, Shaw J. The Australian diabetes obesity and lifestyle study (AusDiab) 2005. Melbourne: International Diabetes Institute; 2006. https://www.baker.edu.au/Assets/Files/AUSDIAB_Report_2005.pdf. Accessed on 31 Oct 2017
Unwin N. Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. The Global Lower Extremity Amputation Study Group. Br J Surg. 2000;87(3):328–37.
National Association of Diabetes Centres (NADC): Australian National Diabetes Audit - Australian Quality Clinical Audit Final Report 2015. Australian Government; 2015. http://www.health.gov.au/internet/main/publishing.nsf/content/pq-diabetes-pubs. Accessed on 31 Oct 2017.
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. 2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. 2013;103(1):2–7. CrossRefPubMed
Lipsky BA, Aragon-Sanchez J, Diggle M, Embil J, Kono S, Lavery L, Senneville E, Urbancic-Rovan V, Van Asten S, International Working Group on the Diabetic F. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 2016;32(Suppl 1):45–74. CrossRefPubMed
Medical Board of Australia: Medical practitioner registrant data: June 2015. Australian Health Practitioner Regulation Agency; 2015. http://www.medicalboard.gov.au/News/Statistics.aspx. Accessed on 31 Oct 2017.
Australasian Society for Infectious Diseases: NZBug Members. Australasian Society for Infectious Diseases; 2015. https://www.asid.net.au/. Accessed on 31 Oct 2017.
Group AE. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2015.
Ingram PR, Cheng AC, Murray RJ, Blyth CC, Walls T, Fisher DA, Davis JS, Australasian Society for Infectious Diseases Clinical Research N. What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore. Clin Microbiol Infect. 2014;20(10):O737–44. CrossRefPubMed
Rerkasem K, Kosachunhanun N, Tongprasert S, Khwanngern K, Matanasarawoot A, Thongchai C, Chimplee K, Buranapin S, Chaisrisawadisuk S, Mangklabruks A. Reducing lower extremity amputations due to diabetes: the application of diabetic-foot protocol in Chiang Mai University Hospital. Int J Low Extrem Wounds. 2008;7(2):88–92. CrossRefPubMed
- Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians
Robert J. Commons
Paul R. Ingram
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- BioMed Central