Many patients with community-acquired diabetic foot infections (DFI) receive systemic (empirical) antibiotic treatments before surgical interventions, often by the general practitioner. Sometimes, hospital clinicians prescribe them before surgery to reduce the infection inoculum and preserve soft tissue for immediate wound closure in case of residual infection after surgery. In contrast, the international guidelines (IWGDF) advocate against presurgical antibiotic use in routine situations without severe progredient soft tissue infections and/or sepsis. We run several retrospective and prospective cohorts of DFI and retrospectively analyze the influence of presurgical antibiotic therapy (as binary (yes/no) or continuous (in days) variables) on failures after a combined surgical and medical treatment. In our large database, the presence, choice, administration routes, or duration of preoperative antibiotic therapy did not improve the postoperative outcomes of operated diabetic foot infections or prevent their failures. In turn, this lack of influence leaves space for enhanced antibiotic stewardship in the management of DFI.
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