How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation
Abstract Introduction The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino‐penicillins and second‐generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-04-01
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| Series: | Endocrinology, Diabetes & Metabolism |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/edm2.225 |
| _version_ | 1818603091672432640 |
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| author | Ilker Uçkay Dominique Holy Madlaina Schöni Felix W. A. Waibel Tudor Trache Jan Burkhard Thomas Böni Benjamin A. Lipsky Martin C. Berli |
| author_facet | Ilker Uçkay Dominique Holy Madlaina Schöni Felix W. A. Waibel Tudor Trache Jan Burkhard Thomas Böni Benjamin A. Lipsky Martin C. Berli |
| author_sort | Ilker Uçkay |
| collection | DOAJ |
| description | Abstract Introduction The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino‐penicillins and second‐generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion. Methods In this prospective observational study, we separately asked 13 experienced (median 11 years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas. Results Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2‐year period, the clinicians' predictive performance did not improve. Conclusion The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs. |
| first_indexed | 2024-12-16T13:17:40Z |
| format | Article |
| id | doaj.art-a95a01063a2c45a289ab7c973822ab13 |
| institution | Directory Open Access Journal |
| issn | 2398-9238 |
| language | English |
| last_indexed | 2024-12-16T13:17:40Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism |
| spelling | doaj.art-a95a01063a2c45a289ab7c973822ab132022-12-21T22:30:27ZengWileyEndocrinology, Diabetes & Metabolism2398-92382021-04-0142n/an/a10.1002/edm2.225How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluationIlker Uçkay0Dominique Holy1Madlaina Schöni2Felix W. A. Waibel3Tudor Trache4Jan Burkhard5Thomas Böni6Benjamin A. Lipsky7Martin C. Berli8Infectiology Balgrist University Hospital Zurich SwitzerlandInternal Medicine Balgrist University Hospital Zurich SwitzerlandDepartment of Orthopedic Surgery Balgrist University Hospital Zurich SwitzerlandDepartment of Orthopedic Surgery Balgrist University Hospital Zurich SwitzerlandDepartment of Orthopedic Surgery Balgrist University Hospital Zurich SwitzerlandInternal Medicine Balgrist University Hospital Zurich SwitzerlandDepartment of Orthopedic Surgery Balgrist University Hospital Zurich SwitzerlandDepartment of Medicine University of Washington Seattle WA USADepartment of Orthopedic Surgery Balgrist University Hospital Zurich SwitzerlandAbstract Introduction The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino‐penicillins and second‐generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion. Methods In this prospective observational study, we separately asked 13 experienced (median 11 years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas. Results Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2‐year period, the clinicians' predictive performance did not improve. Conclusion The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs.https://doi.org/10.1002/edm2.225clinical predictiondiabetic foot infectionsPseudomonas aeruginosa |
| spellingShingle | Ilker Uçkay Dominique Holy Madlaina Schöni Felix W. A. Waibel Tudor Trache Jan Burkhard Thomas Böni Benjamin A. Lipsky Martin C. Berli How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation Endocrinology, Diabetes & Metabolism clinical prediction diabetic foot infections Pseudomonas aeruginosa |
| title | How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation |
| title_full | How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation |
| title_fullStr | How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation |
| title_full_unstemmed | How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation |
| title_short | How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation |
| title_sort | how good are clinicians in predicting the presence of pseudomonas spp in diabetic foot infections a prospective clinical evaluation |
| topic | clinical prediction diabetic foot infections Pseudomonas aeruginosa |
| url | https://doi.org/10.1002/edm2.225 |
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