Article

Diabetologia

, Volume 53, Issue 10, pp 2249-2255

First online:

Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers

  • A. SottoAffiliated withInstitut National de la Santé et de la Recherche Médicale, ESPRI 26, Université de Montpellier 1, UFR de Médecine
  • , J.-L. RichardAffiliated withDiabetic Foot Unit, University Hospital Nîmes
  • , C. CombescureAffiliated withDivision of Clinical Epidemiology, Geneva University Hospital, University of Geneva
  • , N. JourdanAffiliated withDepartment of Endocrinology, University Hospital Caremeau
  • , S. SchuldinerAffiliated withDiabetic Foot Unit, University Hospital Nîmes
  • , N. BouzigesAffiliated withInstitut National de la Santé et de la Recherche Médicale, ESPRI 26, Université de Montpellier 1, UFR de MédecineDepartment of Bacteriology, University Hospital Caremeau
  • , J.-P. LavigneAffiliated withInstitut National de la Santé et de la Recherche Médicale, ESPRI 26, Université de Montpellier 1, UFR de MédecineDepartment of Bacteriology, University Hospital Caremeau Email author 

Abstract

Aims/hypothesis

In 2003, guidelines for management of diabetic foot infection (DFI) were written by the authors’ team according to the guidelines of the International Working Group on the Diabetic Foot. The effects of implementing these guidelines on the microbiology and costs of infected diabetic foot ulcers were assessed.

Methods

From 2003 to 2007, potential beneficial effects of implementing these guidelines were assessed by comparison over time of bacteriological data (number of bacterial samples, number of microorganisms isolated in cultures, prevalence of multidrug-resistant organisms [MDRO] and colonising flora), and costs related to use of antimicrobial agents and microbiology laboratory workload.

Results

The study included 405 consecutive diabetic patients referred to the Diabetic Foot Unit for a suspected DFI. From 2003 to 2007, a significant decrease was observed in the median number of bacteria species per sample (from 4.1 to 1.6), prevalence of MDRO (35.2% vs 16.3%) and methicillin-resistant Staphylococcus aureus (52.2% vs 18.9%) (p < 0.001). Moreover, prevalence of pathogens considered as colonisers dramatically fell from 23.1% to 5.8% of all isolates (p < 0.001). In parallel, implementation of guidelines was associated with a saving of €14,914 (US$20,046) related to a reduced microbiology laboratory workload and €109,305 (US$147,536) due to reduced prescription of extended-spectrum antibiotic agents.

Conclusions/interpretation

Implementation of guidelines for obtaining specimens for culture from patients with DFI is cost-saving and provides interesting quality indicators in the global management of DFI.

Keywords

Cost Diabetic foot ulcer Guidelines Infection Multidrug-resistant organisms