Effectiveness of the multimodal strategy to reduce multidrug-resistant organisms acquisition in diabetic foot infections: A quasi-experimental study.

BACKGROUND

Multidrug-resistant organisms complicate diabetic foot infections (MDR-DFI) and are associated with adverse clinical and economic outcomes. Effective prevention strategies remain limited.

METHODS

A quasi-experimental study was conducted at a Thai tertiary care hospital (January 2024-January 2026). The multimodal strategy included early surgical debridement, a predictive nomogram for risk-based isolation, standardized wound cultures, personalized, patient-specific antibiotic therapy, and enhanced infection prevention and control monitoring. The primary outcome was the cumulative incidence of MDR-DFI acquisition. Secondary outcomes included length of stay, 28-day recurrence, and DFI treatment costs.

RESULTS

Among 100 patients, the cumulative incidence of MDR-DFI acquisition significantly decreased post-intervention (6.0% vs 38.0%; P < .001). The strategy was associated with shorter length of stay (13.2 ± 9.7 vs 19.3 ± 16.2 days; P = .03), lower 28-day recurrence (2.0% vs 18.0%; P = .02), and reduced costs (USD 1,933 vs 2,664; P = .04). Amputation, mortality, and readmission rates showed no significant differences.

DISCUSSION: Integration of surgical management, risk stratification, personalized antibiotic therapy, and infection prevention and control measures may help address modifiable risk factors contributing to MDR-DFI.

CONCLUSIONS

A multimodal strategy effectively reduced MDR-DFI acquisition and supports quality improvement in DFI management.