+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections-A daily practice cohort

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections-A daily practice cohort

Endocrinology, Diabetes and Metabolism 2(2): E00059

The appropriate duration of antibiotic therapy for diabetic foot infections (DFI) after surgical amputations in toto is debated. There are discrepancies worldwide. Using a clinical pathway for adult DFI patients (retrospective cohort analysis), we conducted a cluster-controlled Cox regression analysis. Minimum follow-up was 2 months. We followed 482 amputated DFI episodes for a median of 2.1 years after the index episode. The DFIs predominately affected the forefoot (n = 433; 90%). We diagnosed osteomyelitis in 239 cases (239/482; 50%). In total, 47 cases (10%) were complicated by bacteremia, 86 (18%) by abscesses and 139 (29%) presented with cellulitis. Surgical amputation involved the toes (n = 155), midfoot (280) and hindfoot (47). Overall, 178 cases (37%) required revascularization. After amputation, the median duration of antibiotic administration was 7 days (interquartile range, 1-16 days). In 109 cases (25%), antibiotics were discontinued immediately after surgery. Overall, clinical failure occurred in 90 DFIs (17%), due to the same pathogens in only 38 cases. In multivariate analysis, neither duration of total postsurgical antibiotic administration (HR 1.0, 95% CI 0.99-1.01) nor immediate postoperative discontinuation altered failure rate (HR 0.9, 0.5-1.5). According to our clinical pathway, we found no benefit in continuing postsurgical antibiotic administration in routine amputation for DFI. In the absence of residual infection (ie, resection at clear margins), antibiotics should be discontinued.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 066712013

Download citation: RISBibTeXText

PMID: 31008367

DOI: 10.1002/edm2.59

Related references

Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation?. Clinical Infectious Diseases 23(2): 286-291, 1996

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections. Foot and Ankle Specialist 2018: 1938640018770285, 2018

A reliable surgical approach for the two-staged amputation in unsalvageable limb and life threatening acute progressive diabetic foot infections: tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation. Foot and Ankle Surgery 17(1): 13-18, 2011

How long to treat with antibiotics following amputation in patients with diabetic foot infections? Are the 2012 IDSA DFI guidelines reasonable?. Journal of Clinical Pharmacy and Therapeutics 38(2): 85-88, 2014

Surgical management of diabetic foot and ankle infections. Foot and Ankle Specialist 3(5): 223-230, 2011

Protocol for evaluating the effects of a foot-ankle therapeutic exercise program on daily activity, foot-ankle functionality, and biomechanics in people with diabetic polyneuropathy: a randomized controlled trial. Bmc Musculoskeletal Disorders 19(1): 400, 2018

The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series. Diabetic Foot and Ankle 5, 2014

Perioperative Glycemic Control and the Effect on Surgical Site Infections in Diabetic Patients Undergoing Foot and Ankle Surgery. Foot and Ankle Specialist 9(1): 24-30, 2016

Diabetic foot infections in the elderly: primary amputation versus 'foot-sparing surgery'. A case report. International Wound Journal 4(4): 315-321, 2007

Diabetic foot infections in older people with end-stage renal disease: primary amputation versus "foot-sparing surgery". Journal of the American Geriatrics Society 55(3): 476-477, 2007

Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabetic Medicine 25(6): 700-707, 2008

Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. Journal of Foot and Ankle Surgery 39(5 Suppl): S1-60, 2001

Control of infection in the diabetic foot: the role of microbiology, immunopathology, antibiotics, and guillotine amputation. Journal of Vascular Surgery 5(5): 787-790, 1987

Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 44(1): 119-124, 2014

Differences in activities of daily living between people with subacute stroke who received knee-ankle-foot and ankle-foot orthoses at admission. Journal of Physical Therapy Science 30(10): 1245-1250, 2018