ArticleFrontiers in endocrinology2026
Integrating clinical data into evidence-based practice: institutional guideline development for diabetic foot infections.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background/objectives: Diabetic foot infections (DFIs) are a major cause of morbidity in low- and middle-income countries such as Pakistan, where antimicrobial resistance (AMR) and the absence of localized guidelines complicate their management. This study aimed to analyze the microbiological profile of DFIs and develop evidence-based, context-specific empirical treatment recommendations. Methods: We conducted a retrospective study at a tertiary care hospital in Pakistan, reviewing all diabetic foot related admissions between January 2022 and December 2023. Patients with clinically suspected infections had wound cultures taken and were classified by infection severity using IDSA/IWGDF criteria. Wound specimens from 400 DFI patients were subjected to culture and CLSI-standard antimicrobial susceptibility testing. Pathogen patterns were analyzed across severity groups. A multidisciplinary stewardship team used these findings, together with international guidelines, to develop severity-specific institutional-based empiric treatment recommendations. Results: A total of 118 culture-positive samples from 400 admissions were analyzed. Gram-negative organisms predominated (62%), followed by Conclusion: This study highlights the limited role of Access antibiotics in DFIs, with Watch agents serving as the main empiric therapy and Reserve drugs reserved for multidrug-resistant cases. Using hospital antibiograms, international standards, and expert consensus, we developed a locally tailored institutional guideline for DFI management, which is expected to enhance patient care and antimicrobial stewardship, with periodic updates required as resistance evolves.
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