Timing of Revascularization and Parenteral Antibiotic Treatment Associated with Therapeutic Failures in Ischemic Diabetic Foot Infections

• Published in: Antibiotics (Basel) Vol. 12; no. 4; p. 685
• Main Authors: Altmann, Dominique, Waibel, Felix W A, Forgo, Gabor, Grigorean, Alexandru, Lipsky, Benjamin A, Uçkay, Ilker, Schöni, Madlaina
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 31.03.2023; MDPI
• Subjects: Amputation; Analysis; Angioplasty; Antibiotics; clinical and microbiological failures; Debridement; Diabetes; Diabetes mellitus; Diabetic foot; diabetic foot infection; Failure; Foot diseases; Infection; Infections; Ischemia; limb ischemia; parenteral antibiotic therapy; Pathogens; Patient compliance; Patients; peripheral arterial disease; Regression analysis; Statistical analysis; Surgery; Tazobactam; Therapy; Time lag; timing of angioplasty; Vascularization; Wound healing; parenteral antibiotic therapy; limb ischemia; peripheral arterial disease; clinical and microbiological failures; timing of angioplasty; diabetic foot infection
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics12040685

For ischemic diabetic foot infections (DFIs), revascularization ideally occurs before surgery, while a parenteral antibiotic treatment could be more efficacious than oral agents. In our tertiary center, we investigated the effects of the sequence between revascularization and surgery (emphasizing the perioperative period of 2 weeks before and after surgery), and the influence of administering parenteral antibiotic therapy on the outcomes of DFIs. Among 838 ischemic DFIs with moderate-to-severe symptomatic peripheral arterial disease, we revascularized 608 (72%; 562 angioplasties, 62 vascular surgeries) and surgically debrided all. The median length of postsurgical antibiotic therapy was 21 days (given parenterally for the initial 7 days). The median time delay between revascularization and debridement surgery was 7 days. During the long-term follow-up, treatment failed and required reoperation in 182 DFI episodes (30%). By multivariate Cox regression analyses, neither a delay between surgery and angioplasty (hazard ratio 1.0, 95% confidence interval 1.0-1.0), nor the postsurgical sequence of angioplasty (HR 0.9, 95% CI 0.5-1.8), nor long-duration parenteral antibiotic therapy (HR 1.0, 95% CI 0.9-1.1) prevented failures. Our results might indicate the feasibility of a more practical approach to ischemic DFIs in terms of timing of vascularization and more oral antibiotic use.