title: Acceptable rates of treatment failure in osteomyelitis involving the diabetic foot: a survey of infectious diseases consultants.
abstract: Shortening the duration of antibiotic therapy is an attractive strategy for delaying the emergence of antimicrobial resistance. The paucity of data about optimal treatment durations hinders adoption of this approach. This study used contingent valuation analysis to identify failure rates for treatment of diabetic foot osteomyelitis acceptable to infectious diseases consultants (IDCs). The Infectious Diseases Society of America's Emerging Infections Network (EIN) provided members with the case scenario and 1 of 10 failure rates; members were asked, assuming delivery of standard therapy, if they would accept or reject the given failure rate. The relationship between specific failure rates and the willingness of IDCs to accept them was analyzed. The median acceptable failure rate for EIN members was 18.1%; 75% of IDCs found a failure rate of 7.8% to be acceptable, and 25% found a rate of 28.4% to be acceptable. The methodology used in this study may prove useful in delineating acceptable treatment failure thresholds, an initial step in shortening durations of antimicrobial therapy.
authors.affiliation: VA Maryland Healthcare System, Dept. of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. eperence@epi.umaryland.edu
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Strausbaugh
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harris
mesh_terms: D000328:Adult; D003141:Communicable Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D003253:Consultants; D003625:Data Collection; D017719:Diabetic Foot / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D017211:Treatment Failure