Endocrine Abstracts

In recent years, there is increased interest in using maggot debridement therapy (MDT) for ulcer treatment. MDT has shown beneficial effects on ulcers’ rate of healing, need for surgical intervention, and number of antibiotic-free days. In this retrospective study, we looked into the effects of MDT on the length of inpatient stay and need for surgical intervention.

Data were collected from 33 randomly selected patients admitted into hospital with primary diagnosis of ulcer, both diabetic and non-diabetic. 18 patients, of whom six were diabetic ulcers, were started on MDT and antibiotics treatment. The remaining patients, all of whom were diabetic ulcers, were treated with antibiotics only (control group). The average inpatient stay for the MDT group was 18 days, with 54% of the length of stay attributed to the MDT. In contrast, the average inpatient stay for the control group was significantly shorter than the MDT group (11.3 days, P=0.0014). There was no significant difference in the need for surgical intervention between the MDT and control groups (11% of MDT patients vs 26.7% of control group, P=0.87), although the relatively smaller number of patients in this study could explain this. The shorter length of inpatient stay observed could be due to the recent availability of ‘hospital-at-home’, of which patients can continue i.v. antibiotics treatment at home, and increased outpatient follow up by podiatrists and clinicians during treatment. We excluded multi-resistant microbes as a contributing factor by analysing the microbiology results.

In conclusion, MDT increases the length of hospital inpatient stay. However, it can potentially be overcome by increasing the funding and experience in managing MDT in an outpatient or community setting, a service not widely available at present in UK. This is necessary for cost-effectiveness since MDT is beneficial in other aspects of ulcer management.