title: Can We Stop Antibiotic Therapy When Signs and Symptoms Have Resolved in Diabetic Foot Infection Patients?
abstract: The study aimed to investigate whether we can stop antibiotic therapy when signs and symptoms have resolved in diabetic foot infection (DFI) patients with different grades of peripheral arterial disease (PAD) and those without PAD, and to determine whether the severity of PAD and infection has an effect on antibiotic therapy duration. A prospective randomized controlled trial of DFI patients was carried out. Patients were randomized into 2 groups when signs and symptoms had resolved: continuing antibiotics group (CAG) and discontinuing antibiotics group (DAG). The recurrence and clinical outcomes were recorded. The recurrence rate of mild infection with mild/moderate PAD was similar in the 2 groups. Compared with CAG, the recurrence rate of mild infection with severe PAD was higher in DAG (P = .030), also for moderate/severe infection with PAD (mild/moderate [P = .032]; severe [P = .008]). No difference was found in the 2 groups (either mild or moderate/severe) for those without PAD. The clinical outcomes of mild infection in patients were similar in the 2 groups. For moderate/severe infection, the healing rate was higher (73.3% vs 48.3%), and the rate of minor/major amputation and death was lower (23.8% vs 49.4%; 6.9% vs 20.7%; 2.0% vs 13.8%) in the CAG. When the clinical signs and symptoms of infection have resolved, it might be appropriate to stop antibiotics for DFI patients without PAD, and also for patients with mild infection with mild/moderate PAD. For patients with mild infection with severe PAD and moderate/severe infection with PAD, we should perhaps continue antibiotic treatment. Continuing antibiotic therapy could improve clinical outcomes for patients with moderate/severe infection.
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Yuejie
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Jinghang
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Tianjin Medical University, Tianjin, China wph200000@163.com.
authors.forename: Penghua
authors.initials: P
authors.lastname: Wang
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Min
authors.initials: M
authors.lastname: Ding
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Xiwen
authors.initials: X
authors.lastname: Li
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Hou
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Shuhong
authors.initials: S
authors.lastname: Feng
authors.affiliation: Tianjin Medical University, Tianjin, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Li
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003657:Decision Making; D017719:Diabetic Foot / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment; D014945:Wound Healing; D014946:Wound Infection / Q000209:etiology / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic therapy; clinical outcomes; diabetic foot; infection