Impact of microbiological characteristics on the costs of treating diabetic foot infection

• Published in: International journal of diabetes in developing countries 2023-04, Vol.43 (2), p.235-243
• Main Authors: Batista, Julianne Soares Jardim Lacerda, Bassetti, Bil Randerson, Kaiser, Thaís Dias Lemos, Vicente, Creuza Rachel, Schuenck, Ricardo Pinto
• Format: Article
• Language: English
• Subjects: Amputation; Antimicrobial agents; Diabetes; Diabetes mellitus; Electronic medical records; Family Medicine; Foot diseases; General Practice; Health Administration; Medical records; Medicine; Medicine & Public Health; Methicillin; Microorganisms; Multidrug resistance; Multidrug resistant organisms; Original Article; Patients; Staphylococcus infections; Ulcers
• ISSN: 0973-3930; 1998-3832
• DOI: 10.1007/s13410-022-01071-6

Objective To investigate the impact of the microbiological profile on the costs of treating diabetic foot infections (DFI). Methods Data was accessed from electronic medical records of a Brazilian public tertiary hospital. The PEDIS score was used to classify ulcers and the risk of subsequent events (non-healing ulcer, need of amputation, death). Microbiological samples were obtained from deep tissue in surgical procedures and identified by standard methods. Information on actual treatment costs was collected in the financial sector. Results We analyzed 117 medical records of 97 patients. The median PEDIS score was 9, and most patients (94.02%) presented a high risk of subsequent events. Most of the 226 microorganisms isolated were Gram-negative (68.14%). Longer hospitalization length and higher costs involved polymicrobial infections (31.92 days; Int $ 21,755.92), multidrug-resistant microorganism (MDR) (29.84 days; Int $ 20,219.99), and methicillin-resistant Staphylococcus aureus (30.25 days; Int $ 20,607.29). The costs with antimicrobials were significantly higher in polymicrobial infection than in monomicrobial and in the presence of MDR than non-multidrug-resistant microorganisms. Conclusions The microbiological profile, number of microorganisms per wound, and bacterial resistance may increase the hospitalization time and costs of treating DFI, suggesting that bacterial culture may be more financially advantageous than applying empirical therapy for DFI at the beginning of the treatment.