382 Introduction of a New Diabetic Foot Treatment Protocol Using an Antibiotic Carrying Biocomposite

Aim Incidence of diabetes is increasing in the UK. This risks diabetic foot infections which are hard to treat and increase burden on the NHS with recurrent admissions for wound management and antibiotics. Stimulan is an absorbable calcium sulfate antibiotic carrier designed to mix with antibiotics and be applied to open wounds to treat infection including osteomyelitis; this delivers targeted local antibiotics at a higher concentration with ability to disregard renal function. This treats infection and ultimately stops recurrent hospital admissions. This quality improvement project looks at the use of Stimulan in a new protocol for the management of diabetic foot infections at a District General Hospital. Method All diabetic foot infections received a protocolled standard of care pathway aimed at grading severity of diabetic foot infection and treating appropriately. When there was a need for debridement of necrotic/infected tissue or drainage of collections, we introduced an intra-operative protocol to debride back to healthy bone, obtain tissue for micro analysis and pack with Stimulan for antibiotic cover. Results 12 patients received a new standard of care including use of Stimulan intra-operatively combined with antibiotics to treat swab proven infections including Proteus Mirabilis, Enterococcous Faecalis/Coli, Staph Aureus/Epidermidis and Klebsiella. 6–12-month follow-up of these patients showed that they had a downgrading of their foot ulcer severity on the Wagner diabetic foot ulcer classification. Conclusions A new protocolled standard of care with the introduction of topical Stimulan mixed with appropriate antibiotics proved effective at treating diabetic foot ulcers complicated by infection.