Point of care tests to assist antibiotic prescribing decisions for diabetic foot ulcer infections
The lifetime risk of developing a diabetic foot ulcer (DFU) approaches 25% in the UK, resulting in direct costs for the care of DFUs at more than £250 million. Diagnosis of DFU infection remains entirely clinical with no objective test at the point of patient care to assist the clinician in antibiotic prescribing decisions.
C reactive protein (CRP), procalcitonin and calprotectin, are all markers of infection that are available as POCTs. However, the prognostic value
of a combination of these results has not yet been evaluated for DFU infection. This pilot study, aiming to recruit 110 adult DFU patients with either no infection or mild ulcer infection, will be based in community podiatry clinics and has 3 main aims:
1) To inform the feasibility of a subsequent RCT, particularly in terms of trial recruitment and use of the POCTs.
2) To determine the cut-off points for optimal negative predictive value (NPV) and positive predictive value (PPV) of a combination of the POCTs using a robust gold standard for ulcer infection. This would give proof of principle that a composite POCT can be safely used to inform the decision about infection/no infection at initial assessment in a community setting.
3) To develop an online educational tool for DFU infection and obtain feedback regarding its effectiveness from experienced clinicians and patients.
Research for Patient & Public Benefit Wales
NISCHR - DRN and Primary Care
SEWTU - Infections
Professor Vincent Piguet , Cardiff University
Professor Keith Harding , Cardiff University
Professor Kerry Hood , Cardiff University
Dr Emma Thomas-Jones , Cardiff University
Dr Clive Gregory , Cardiff University
Scott Cawley, Cardiff and Vale University Health Board
Dr Nick Francis , Cardiff University
Tim Pickles , Cardiff University
Jane Lewis, Cardiff and Vale University Health Board
Trial Manager: Elinor Coulman , Cardiff University