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首页> 外文期刊>Endocrinology, Diabetes & Metabolism >How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation
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How good are clinicians in predicting the presence of Pseudomonas spp. in diabetic foot infections? A prospective clinical evaluation

机译：临床医生预测假单胞菌SPP的存在有多好。 在糖尿病足部感染？ 预期临床评价

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Introduction The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino‐penicillins and second‐generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion. Methods In this prospective observational study, we separately asked 13 experienced (median 11?years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas . Results Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2‐year period, the clinicians' predictive performance did not improve. Conclusion The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs.
机译：引言用于轻度和中度糖尿病足部感染（DFIS）的最常规定的经验抗生素剂（DFIS）是氨基 - 青霉素和第二代头孢菌素，其不覆盖假单胞菌SPP。许多临床医生认为，他们可以通过视觉和/或嗅觉线索预测伪表达在DFI中的参与，但没有数据支持这种断言。方法在这项前瞻性观察研究中，我们分别被问到13名经验丰富的（中位数11？年）医疗保健工人是否认为是假单胞菌SPP。会涉及到DFI中。将它们的预测与深/术中标本的培养结果进行了比较和/或通过未覆盖假单胞菌的抗生素剂实现的DFI的临床缓解。结果88例患者221个DFI发作中，术中组织培养物在22例（10％）中占Pseudomonas（包括六个骨样品）。用0.32的灵敏度正确预测假单胞菌的存在，比0.84的特异性，阳性预测值为0.18和负预测值0.92。尽管临时结果和2年期间有两次反馈，但临床医生的预测性能并未改善。结论经验丰富的临床医生的综合视觉和嗅觉性能预测DFI在DFI中假单胞菌存在的存在是中等的，具有比敏感性更好的特异性，并且随着时间的推移没有改善。需要进一步调查来确定临床医生是否应该在DFI中使用假单胞菌存在的阴性预测，特别是在具有伪症DFI流行高的环境中。

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