{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T09:00:04Z","timestamp":1777712404369,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T00:00:00Z","timestamp":1649635200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>\n                    Diabetic foot infections (DFIs) are associated with major morbidity, reduced quality of life and increased mortality. Osteomyelitis is a leading cause of lower-extremity amputation in diabetic patients. We aimed to examine whether a multifaceted strategy for treating hospitalized patients with a DFI effectively influenced microbiological culture results and outcomes. A retrospective cohort-study in a 1100-bed, tertiary-care university hospital was conducted. Adult patients with a DFI admitted to the orthopedics department between 2015 and 2019 were included. During the pre-intervention period (2015-2016), one general orthopedic department was in operation. In the post-intervention period (2017-2019), a second department was created with a designated \u201ccomplicated wound unit\". The multifaceted strategy included revising local guidelines for DFI culturing emphasizing bone cultures, correct sample handling, and adjusting antibiotic treatment to culture results. Additionally, a weekly multidisciplinary-team grand round was instigated and post-discharge outpatient follow-up was scheduled. 652 patients with DFIs were included; 101 during the pre-intervention period and 551 during the post-intervention period. Compared to the pre-intervention, during the post-intervention period mainly bone or deep-tissue cultures were performed (9.7% vs. 98.2%, P\u2009&lt;\u20090.001). Bacteriology cultures in the pre-intervention versus post-intervention period revealed: among staphylococcus isolates, fewer methicillin-resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    detected (20.4% vs. 9.8%, P\u2009=\u20090.010); within Enterobacteriaceae isolates, fewer extended-spectrum \u03b2-lactamase producing bacteria detected (51.6% vs. 23.6%, P\u2009&lt;\u20090.001); a decrease in\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    isolates (28% vs. 10.6%, P\u2009&lt;\u20090.001) and an increase in anaerobic bacterial isolates (0 vs. 11.1%, P\u2009&lt;\u20090.001). On multivariate regression, the post-intervention period (ie multifaceted strategy) was a protective measure against readmissions (P\u2009=\u20090.007 OR 0.50 95% CI 0.30-0.82). We conclude that our interventive multifaceted strategy led to accurate bacterial diagnosis, de-escalation of antibiotic treatment and readmission reduction.\n                  <\/jats:p>","DOI":"10.1177\/15347346221093463","type":"journal-article","created":{"date-parts":[[2022,4,11]],"date-time":"2022-04-11T10:16:52Z","timestamp":1649672212000},"page":"342-348","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Multifaceted Strategy Improves Outcomes of Patients Hospitalized with a Diabetic Foot Infection"],"prefix":"10.1177","volume":"24","author":[{"given":"Elad","family":"Keren","sequence":"first","affiliation":[{"name":"Orthopedic Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Borer","sequence":"additional","affiliation":[{"name":"Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"},{"name":"Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tali","family":"Shafat","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-0428","authenticated-orcid":false,"given":"Lior","family":"Nesher","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaniv","family":"Faingelernt","sequence":"additional","affiliation":[{"name":"The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orli","family":"Sagi","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orly","family":"Shimoni","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 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