title: [Outpatient parenteral antibiotic therapy (OPAT) of diabetic foot infections with piperacillin/tazobactam].
abstract: Treatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to different degrees of severity according to Wagner's classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram - and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programmes
authors.affiliation: Divisione di Chirurgia, Ospedale Santa Maria delle Grazie, Pozzuoli, Napoli, Naples.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marvaso
authors.forename: Silvano
authors.initials: S
authors.lastname: Esposito
authors.forename: Silvana
authors.initials: S
authors.lastname: Noviello
authors.forename: Filomena
authors.initials: F
authors.lastname: Ianniello
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Leone
authors.forename: A
authors.initials: A
authors.lastname: Maiello
authors.forename: Pasquale
authors.initials: P
authors.lastname: Petronella
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy*; D017719:Diabetic Foot / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage*; D000077725:Piperacillin, Tazobactam Drug Combination; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin