Dataset Information

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 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.

SUBMITTER: Uckay I

PROVIDER: S-EPMC8029573 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

How good are clinicians in predicting the presence of <i>Pseudomonas</i> spp. in diabetic foot infections? A prospective clinical evaluation.

Uçkay Ilker I Holy Dominique D Schöni Madlaina M Waibel Felix W A FWA Trache Tudor T Burkhard Jan J Böni Thomas T Lipsky Benjamin A BA Berli Martin C MC

Endocrinology, diabetes & metabolism 20210209 2

<h4>Introduction</h4>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 <i>Pseudomonas</i> spp. Many clinicians believe they can predict the involvement of <i>Pseudomonas</i> in a DFI by visual and/or olfactory clues, but no data support this assertion.<h4>Methods</h4>In this prospective observational study, we separately asked 13 experienced (median 11 years ...[more]

PMID: 33855224

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