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Abstracts from The College of Podiatry Annual Conference 2016

2017; BioMed Central; Volume: 10; Issue: S1 Linguagem: Inglês

10.1186/s13047-017-0191-8

1757-1146

J.R. Ingram, Scott Cawley, Angela Jones, Elinor Coulman, Clive Gregory, Timothy Pickles, Him Shun Hinson Kei, Paul Fletcher, Mike Curran, Trevor Prior, Cynthia Formosa, Simon Otter, Keith Rome, Peter Gow, Nicola Dalbeth, Maheswaran Rohan, Sarah Stewart, Ashok Aiyer, Sam Glasser, Joanne Paton, Richard Collings, Jonathan Marsden, David Torgerson, Sarah Cockayne, Sara Rodgers, Lorraine Green, Caroline Fairhurst, Joy Adamson, Arabella Clark, Belén Corbacho, Catherine Hewitt, Kate Hicks, Robin Hull, Anne‐Maree Keenan, Sarah E Lamb, Hylton B. Menz, Anthony C. Redmond, Zoe Richardson, Wesley Vernon, Judith Watson, Lisa Farndon, Belén Corbacho, Sarah Cockayne, Sara Rodgers, Lorraine Green, Caroline Fairhurst, Joy Adamson, Arabella Clarke, Catherine Hewitt, Kate Hicks, Robin Hull, Anne‐Maree Keenan, Sarah E Lamb, Caroline McIntosh, Hylton B. Menz, Anthony C. Redmond, Zoe Richardson, Wesley Vernon, Judith Watson, Lisa Farndon, David Torgerson, Joanne Paton, Sam Glasser, Richard Collings, Jonathan Marsden, Stephen Mizzi, Lucianne Cutajar, Annabelle Mizzi, Owen Falzon, Ian Swaine, Kate Springett, Sarah Cockayne, Sara Rodgers, Lorraine Green, Caroline Fairhurst, Joy Adamson, Arabella Clarke, Belén Corbacho, Catherine Hewitt, Kate Hicks, Robin Hull, Anne‐Maree Keenan, Sarah E Lamb, Caroline McIntosh, Hylton B. Menz, Anthony C. Redmond, Zoe Richardson, Wesley Vernon, Judith Watson, Lisa Farndon, David Torgerson, Simon Otter, Keith Rome, Peter Gow, Nicola Dalbeth, Maheswaran Rohan, Sarah Stewart, Ashok Aiyer, Trevor Prior, Andrea Bachand, Ben Avison, Jessica Leitch, Jennifer Scott, Gordon Hendry, Jackie Locke, Carla McArdle, Katie Lagan, D.A. McDowell, Michelle Kaminski, Anita Raspovic, Lawrence P. McMahon, Katrina A. Lambert, Bircan Erbas, Peter F. Mount, Peter Kerr, Karl B. Landorf, Louis Mamode, Catherine Bowen, Malcolm Burnett, Lucy Gates, Ann Ashburn, Mark Cole, Maggie Donovan‐Hall, Ruth Pickering, Dan L. Bader, Judy Robison, Dorit Kunkel, Saed A. Al Bimani, Lucy Gates, Martin Warner, Catherine Bowen, Jane Murchie, Rachel Hannigan, Carla McArdle, Mairghread Jh Ellis, Aimie Patience, Sophie Slater, Kirsten Wallace, Katherine Edwards, Alan Borthwick, Louise McCulloch, Anthony C. Redmond, Rafael Pinedo‐Villanueva, Nigel Arden, Catherine Bowen, Heidi J. Siddle, Péter Mandl, Daniel Aletaha, T. P. M. Vliet Vlieland, Marina Backhaus, P. Cornell, Maria Antonietta D’Agostino, Karen Ellegaard, Annamaria Iagnocco, B. Jakobsen, T. Jasinski, N.H. Kildal, Michaela Lehner, Ingrid Möller, Gabriela Supp, Philip O’Connor, Anthony C. Redmond, Esperanza Naredo, Richard J. Wakefield,

Diversity and Career in Medicine

BackgroundAssessing diabetic foot ulcers (DFUs) for infection is difficult because clinical symptoms and signs may be masked by neuropathy and vasculopathy and there are no objective tests available at point of care to guide clinicians.Empirical prescription of antibiotics compromises antibiotic stewardship, while missing early infection may lead to severe infection and amputation.In 2011-12, the cost of managing DFUs and associated amputations borne by NHS England was £650 million, nearly 1% of its budget.Our INDUCE study had two aims: (1) to develop an online educational tool for DFU infection and (2) to conduct a pilot study investigating C-reactive protein (CRP) and procalcitonin from venous blood and calprotectin from wound exudate as inflammatory biomarkers of mild DFU infection.Methods Yola software was used to develop an online educational tool covering DFU history and examination, arterial assessment, microbiology, radiology and management of osteomyelitis.The tool contains links to NICE guidance and other relevant learning resources.A quiz using patient scenarios is included.Feedback from podiatrists was elicited by questionnaires and a focus group.Patients with non-infected or mildly infected DFUs were recruited from community podiatry clinics in 2 UK regions.Exclusion criteria included immunosuppression or receipt of antibiotics within the previous 2 weeks.Antibiotics were prescribed based on clinical judgement at the baseline assessment.Our gold standard defining DFU infection was the clinician's judgement one week later, while still blinded to test results, factoring in the response to antibiotic therapy, if prescribed.All 3 inflammatory biomarkers were measured at weeks 0 and 1, including assessment of CRP using a point-of-care device. ResultsFeedback regarding the educational tool from end-users ranging from trainee to senior podiatrists was very positive.The main improvement requested was a printable certificate after successful completion of the quiz and provision of CPD points.Between September 2014 and September 2015, the INDUCE study recruited 67 patients with DFUs, from a total of 363 potential participants.Primary endpoints were available for 37 participants with non-infected ulcers and 28 with mild infection, following early study withdrawal by one patient in each group.Median CRP was slightly higher in the infected ulcer group, 7.50 mg/ml compared to 6.00 mg/ml for noninfected ulcers, but the area under the receiver operating characteristic curve (AUROC) was only 0.52, demonstrating poor predictive efficacy.Most of the procalcitonin results were below the lower limit of the assay and levels were lower in the infected DFU group.Median calprotectin levels were nearly doubled in infected ulcers, 1437 ng/ml compared with 879 ng/ml in non-infected DFUs, but with an insufficient AUROC of 0.56.Conclusions Feedback from a range of podiatrists confirmed that assessment of DFU infection remains challenging and showed that the INDUCE tool is a useful learning resource.The tool will be made freely available via the internet.Based on their sensitivity and specificity, neither venous CRP or procalcitonin should be pursued as biomarkers of DFU infection, alone or in combination.Calprotectin in wound exudate may have value, but only in combination with other biomarkers.