Variation in Antibiotic Treatment for Diabetic Patients with Serious Foot Infections: A Retrospective Observational Study


Show simple item record Fincke, Benjamin G en_US Miller, Donald R en_US Christiansen, Cindy L en_US Turpin, Robin S en_US 2011-12-29T23:07:48Z 2011-12-29T23:07:48Z 2010 en_US 2010-7-6 en_US
dc.identifier.citation Fincke, Benjamin G, Donald R Miller, Cindy L Christiansen, Robin S Turpin. "Variation in antibiotic treatment for diabetic patients with serious foot infections: A retrospective observational study." BMC Health Services Research 10:193. (2010) en_US
dc.identifier.issn 1472-6963 en_US
dc.description.abstract BACKGROUND: Diabetic foot infections are common, serious, and diverse. There is uncertainty about optimal antibiotic treatment, and probably substantial variation in practice. Our aim was to document whether this is the case: A finding that would raise questions about the comparative cost-effectiveness of different regimens and also open the possibility of examining costs and outcomes to determine which should be preferred. METHODS: We used the Veterans Health Administration (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct a retrospective observational study of hospitalized patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for VA patients with diabetes since 1998, including demographics, ICD-9-CM diagnostic codes, antibiotics prescribed, and VA facility. We identified all patients with ICD-9-CM codes for cellulitis/abscess of the foot and then sub-grouped them according to whether they had cellulitis/abscess plus codes for gangrene, osteomyelitis, skin ulcer, or none of these. For each facility, we determined: 1) The proportion of patients treated with an antibiotic and the initial route of administration; 2) The first antibiotic regimen prescribed for each patient, defined as treatment with the same antibiotic, or combination of antibiotics, for at least 5 continuous days; and 3) The antibacterial spectrum of the first regimen. RESULTS: We identified 3,792 patients with cellulitis/abscess of the foot either alone (16.4%), or with ulcer (32.6%), osteomyelitis (19.0%) or gangrene (32.0%). Antibiotics were prescribed for 98.9%. At least 5 continuous days of treatment with an unchanged regimen of one or more antibiotics was prescribed for 59.3%. The means and (ranges) across facilities of the three most common regimens were: 16.4%, (22.8%); 15.7%, (36.1%); and 10.8%, (50.5%). The range of variation across facilities proved substantially greater than that across the different categories of foot infection. We found similar variation in the spectrum of the antibiotic regimen. CONCLUSIONS: The large variations in regimen appear to reflect differences in facility practice styles rather than case mix. It is unlikely that all regimens are equally cost-effective. Our methods make possible evaluation of many regimens across many facilities, and can be applied in further studies to determine which antibiotic regimens should be preferred. en_US
dc.description.sponsorship Merck and Company Incorporated en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2010 Fincke et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri en_US
dc.title Variation in Antibiotic Treatment for Diabetic Patients with Serious Foot Infections: A Retrospective Observational Study en_US
dc.type article en_US
dc.identifier.doi 10.1186/1472-6963-10-193 en_US
dc.identifier.pubmedid 20604922 en_US
dc.identifier.pmcid 2914722 en_US

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