1555. Evaluation of Local Pathogens and Management of Diabetic Foot Infections

BACKGROUND: Diabetic foot infections (DFI) are a potentially devastating complication for patients with diabetes. When treating these patients, there is a need for selection of highly effective antibiotics coupled with a need to avoid excessive use of broad-spectrum antimicrobial agents that could lead to adverse patient outcomes. At this institution, it has been observed that there is a lack of compliance with consensus guideline recommendations for the choice of empiric antibiotic therapy for DFI, leading to overuse of broad-spectrum antibiotics. METHODS: A retrospective chart review was performed for hospitalized patients over 18 years of age that received antibiotics for DFI during the period of August 1, 2018 to July 31, 2019. Patients were excluded if they were continuing outpatient antibiotics for an existing DFI, were being treated with antibiotics for a concurrent infection, or were pregnant. The primary objective was the rate of guideline-compliant empiric antibiotic regimens as broken down by infection severity. Secondary objectives included the duration of antibiotic therapy per patient, and rates of empiric methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa coverage. RESULTS: A total of 114 patients were included in the analysis. A majority of patients had an infection of moderate severity (65.8%), followed by 19.3% with severe infections, and 14.9% with mild infections. In the total population, only 26.3% of patients received empiric antibiotic regimens that were guideline-compliant. A large percentage of patients received empiric anti-MRSA antibiotics (95.6%) and empiric anti-pseudomonal agents (89.5%). Use of these broad-spectrum agents did not differ by infection severity. Ninety-nine (86.8%) patients had a site culture collected. S. aureus was the most commonly isolated organism and there was a low rate of P. aeruginosa (10.1%). CONCLUSION: There is room for improvement in the management of DFI at this institution. A specific area that has been identified is the overuse of empiric anti-pseudomonal agents in patients without risk factors for P. aeruginosa. The results of this study will be evaluated alongside consensus guidelines and used to create institution-specific treatment guidance that providers can employ to optimize the management of DFI. DISCLOSURES: All Authors: No reported disclosures