MANAGEMENT AND OUTCOME OF SEVERE DIABETIC FOOT INFECTIONS

We evaluated the bacteriological and clinical efficacy of the combinat ion of ciprofloxacin /clindamycin in severe diabetic foot infections a nd we tried to elucidate the relationship between the vascular status of the lower limbs and the outcome of these infections. Initial empiri cal antibiotic therapy with ciprofloxacin (300 mg/ 12 hrs IV) and clin damycin (600 mg/8 hrs IV) was administered in 84 hospitalized diabetic s with severe lower limb infections. This treatment was continued only in cases with primary clinical improvement. The major endpoints of tr eatment were: cure, improvement and failure. Evaluation of the vascula r status of the lower extremities was performed by high resolution ima ging coloured ultrasonography, US-Doppler and TcPO2 measurements. Poly microbial flora was found in 83% of the cases with an average 2.8 spec ies per specimen. Osteomyelitis was detected in 58% of the patients. A fter five days of IV administration of ciprofloxacin and clindamycin t he response rate was 95.2%. After three weeks of therapy the clinical outcome was: cure 54.8%, improve ment 23.8%, and failure 21.4%. The lo ng term follow up (mean duration 16 months) revealed complete healing of the skin lesions in 63 patients (75%). Unfavorable prognostic facto rs for these infections were: ankle systolic blood pressure <50 mmHg o r toe systolic blood pressure <30 mmHg and TcPO2 < 20 mmHg. The side e ffects of the combination of ciprofloxacin/clindamycin were mild and t here were no cases of pseudomembranous enterocolitis. The combination of ciprofloxacin/clindamycin was found to provide an excellent empiric al as well as definitive treatment of severe diabetic foot infections. The evaluation of the vascular status and the severity of ischaemia o f the lower limbs has a strong predictive value in the outcome of thes e infections.