Narrow-spectrum antibiotics suffice in stable patients of diabetic foot infection after surgical debridement

Arend J. Nieuwland et al. and colleagues have concluded that the microbiological adequacy of the initial antibiotic regimen after (surgical) debridement for diabetic foot infections or DFI did not alter therapeutic outcomes. They recommended clinicians follow the stewardship approach of avoiding antibiotic de-escalation and start with a narrow-spectrum regimen (local epidemiology based).

Researchers from the Balgrist University Hospital and the University of Washington evaluated clinical and microbiological outcomes following combined surgical and medical therapy for DFI (empirical versus the targeted nature and empirical broad versus a narrow-spectrum antibiotic therapy).

They assessed the therapeutic failure rate for adequate empirical, culture-guided, and empirical inadequate therapy with a switch to targeted treatment based on available microbiological results.

The key results of the study are:

• Researchers included data from 332 patients.
• These patients underwent 716 DFI episodes of surgical debridement, including partial amputations.
• 40/190 episodes (20/6 %), 77/291 episodes (26.5%), and 73/231 episodes (31.6%) had Clinical failure where adequate empirical therapy, culture-guided (and correct) therapy from the start, and switching from empirical inadequate to culture-targeted therapy were provided respectively.
• This failure risk could not be altered by broad-spectrum antibiotic choice.

They said, “We found that selecting an initial broad-spectrum antibiotic regimen failed to reduce clinical failure risk in treating localized DFIs.

They noted that our findings regarding effective antibiotic stewardship in global management are crucial.

The researchers advocate for considering a narrow-spectrum postoperative antibiotic regimen in stable patients with local DFIs that have been surgically debrided.

Further reading:

Nieuwland AJ, Waibel FWA, Flury A, Lisy M, Berli MC, Lipsky BA, Uçkay İ, Schöni M. Initial antibiotic therapy for postoperative moderate or severe diabetic foot infections: Broad versus narrow spectrum, empirical versus targeted. Diabetes Obes Metab. Published ahead of print on August 2, 2023. doi 10.1111/dom.15228.