糖尿病足感染管理中抗生素管理原则与实践的一致性如何:一项院内质量控制研究。

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2024-06-28 eCollection Date: 2024-01-01 DOI:10.5194/jbji-9-183-2024
Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, Parham Sendi
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引用次数: 0

摘要

导言:糖尿病足感染(DFI)诊断和治疗概念的标准化具有挑战性。2019 年,我院引入了有关 DFI(包括骨髓炎(DFO))诊断原则和抗生素治疗(ABT)的具体建议。在本研究中,我们评估了这些内部指南实施两年后的遵守情况。方法:纳入在 2019 年至 2021 年期间接受手术治疗的伴有或不伴有 DFO 的 DFI 成人患者。对患者的病历进行了回顾性审查。评估了患者对活检取样、标签、要求微生物学和组织病理学检查以及治疗持续时间等建议的遵守情况。结果共纳入 80 名患者,住院 117 次,手术 163 次;84.6% 的患者需要截肢。与 HbA1c 水平≥ 6.5% 的患者相比,HbA1c 水平为 6.5% 的患者在同一次住院期间需要进行翻修的比例更高(分别为 29.4% 和 12.1%,P = 0.023)。71.8%的手术获得了标本,63.2%的标本被送去进行组织学检查。在宏观手术治愈的病例中,ABT 的平均持续时间为 9 天(四分位数间距 (IQR) 5-15 天),而在切除边缘为非健康骨骼的病例中,ABT 的平均持续时间为 40.5 天(四分位数间距 (IQR) 15-42 天)(P 0.0001)。使用组织学结果时,治疗持续时间结果相似:健康骨骼的治疗时间为 13 天(IQR 8-42),而骨髓炎切除边缘的治疗时间为 29 天(IQR 13-42)(P = 0.026)。结论:对活检取样建议的依从性良好,对组织病理学分析的依从性一般,而对解剖位置标记的依从性较差。对 ABT 治疗时间建议的遵守情况良好,但有必要进一步缩短手术治愈病例的治疗时间。
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What is the agreement between principles and practice of antibiotic stewardship in the management of diabetic foot infection: an in-hospital quality control study.

Introduction: Standardization of diagnostic and treatment concepts in diabetes-related foot infection (DFI) is challenging. In 2019, specific recommendations regarding diagnostic principles and antibiotic therapy (ABT) for DFI, including the one for osteomyelitis (DFO), were introduced in our institution. In this study, we assessed the adherence to these in-house guidelines 2 years after their implementation. Methods: Adult patients with DFI with and without DFO who underwent surgical intervention between 2019 and 2021 were included. Patients' charts were retrospectively reviewed. Accordance to recommendations regarding biopsy sampling, labeling, requesting microbiological and histopathological examinations, and treatment duration were assessed. Results: A total of 80 patients with 117 hospital episodes and 163 surgical interventions were included; 84.6 % required an amputation. Patients with HbA1c levels of < 6.5  % more often required a revision during the same hospitalization than those with HbA1c levels of 6.5  % (29.4 % vs. 12.1 %, respectively, p = 0.023 ). Specimens were obtained in 71.8 % of operations and sent for histological examination in 63.2 %. The mean duration of ABT was 9 (interquartile range (IQR) 5-15) d in macroscopically surgically cured episodes and 40.5 (IQR 15-42) d in cases with resection margins in non-healthy bone ( p < 0.0001 ). Treatment duration results were similar when using histological results: 13 (IQR 8-42) d for healthy bone vs. 29 (IQR 13-42) d for resection margins consistent with osteomyelitis ( p = 0.026 ). Conclusion: The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathological analysis and poor for labeling the anatomic location. Adherence to recommendations for ABT duration was good, but further shortening of treatment duration for surgically cured cases is necessary.

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CiteScore
3.70
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0.00%
发文量
29
审稿时长
12 weeks
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