508-P: Association between Initial Outpatient Diabetic Foot Ulcers Infection Management Strategy and Hospitalization Free

The objective was to evaluate the impact of the initial management strategies for DFU infections diagnosed at an outpatient multidisciplinary center. In 2019, people with newly diagnosed DFU infection were followed for duration of therapy to determine hospitalization rates within 30 days of diagnosis. Consecutive patients were stratified according to Infectious Disease Society of America infection severity. Demographic, socioeconomic, and antibiotic data was recorded. Among 147 persons treated for DFU infection, 59% infections were mild, while 30% and 4% were moderate and severe, respectively. Empiric antibiotics, consisting of either a cephalosporin or penicillin (76%) were prescribed for initial treatment in 116 individuals, and 66% (n=77) of these had tissue cultures preceding the treatment. Despite initial management of outpatient infection, 42% of the entire cohort required hospitalization within 30 days of diagnosis; 50%, 38%, and 12% hospitalizations were mild, moderate, and severe infections, respectively. The percentage of hospitalizations which occurred in mild infection treated with only empiric antibiotic (58%) was 1.5x greater than culture-directed antibiotic therapy (34%) despite similar empiric antibiosis. High rates of hospitalizations occurred in moderate (49%) and severe (100%) DFU infection. Overall, there was a negative association (r = -0.50, p<0.05) between implementation of culture-directed antibiotic strategy and hospitalization, and increased hospitalizations with applying empiric therapy for mild DFU infection. These data strongly support the practice to obtain tissue culture regardless of DFU infection severity to guide further treatment, as it is negatively associated with hospitalization rates. It is therefore essential to ensure foot infection treatment involves culture-directed antibiotic therapy and is applied uniformly across infection severity.