#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Diabetic foot infection – diagnosis and treatment


Authors: Robert Bém
Authors‘ workplace: Centrum diabetologie, Institut klinické a experimentální medicíny, Praha
Published in: Vnitř Lék 2023; 69(1): 25-30
Category: Review Articles
doi: https://doi.org/10.36290/vnl.2023.003

Overview

Diabetic foot (DF) is one of the most serious complications of diabetes, leading to high morbidity and mortality in patients with diabetes, significantly affecting their quality of life and placing a huge burden on the healthcare system. Diabetic foot infection (DFI) is a major factor in the non-healing of diabetic ulcerations of the lower limbs, increases the number of hospital admissions, prolongs their duration and is a frequent cause of increased number of amputations. The most serious form of foot infection is osteomyelitis. Management of infection in SDN includes proper diagnosis, including obtaining appropriate specimens for culture, indication of rational antimicrobial therapy or early surgical intervention, and provision of all other necessary wound care and overall patient care to prevent recurrence of DFI.

Keywords:

diabetes mellitus – diabetic foot – infection


Sources

1. IWGDF. International Consensus on the Diabetic Foot. 2019.

2. Apelqvist J. The foot in perspective. Diabetes Metab Res Rev. 2008;24 (Suppl) 1:S110-5.

3. Van Netten JJ, Woodburn J, Bus SA. The future for diabetic foot ulcer prevention: A paradigm shift from stratified healthcare towards personalized medicine. Diabetes Metab Res Rev. 2020;36 Suppl 1:e3234.

4. Bem R, Dubsky M, Fejfarova V, Husakova J, Woskova V. Diabetic foot. Vnitr Lek. 2020;66(2):92-7.

5. Harb M, Greige W, Ephrem C. Infected diabetic ulcers, when to amputate. J Infect Dev Ctries. 2018;12(2.1):21S.

6. Prompers L, Huijberts M, Apelqvist J, Jude E, Piaggesi A, Bakker K, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007;50(1):18-25.

7. Laowahutanon T, Nakamura H, Tachimori H, Nomura S, Liabsuetrakul T, Lim A, et al. Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical‑trend analysis, 2009-2016. PLoS One. 2021;16(7):e0253434.

8. Nieto‑Gil P, Ortega‑Avila AB, Pardo‑Rios M, Cobo‑Najar M, Blasco‑Garcia C, Gijon‑Nogueron G. Hospitalisation Cost of Patients with Diabetic Foot Ulcers in Valencia (Spain) in the Period 2009(-)2013: A Retrospective Descriptive Analysis. Int J Environ Res Public Health. 2018;15(9).

9. Lipsky BA, Senneville E, Abbas ZG, Aragon‑Sanchez J, Diggle M, Embil JM, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 (Suppl) 1:e3280.

10. Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect, DiS. 2007;44(4):562-5.

11. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93.

12. Wang A, Lv G, Cheng X, Ma X, Wang W, Gui J, et al. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). Burns Trauma. 2020;8:tkaa017.

13. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non‑Hispanic whites from a diabetes disease management cohort. Diabetes Care. 2003;26(5):1435-8.

14. Daneshvar K, Anwander H. Diagnostic Imaging of Diabetic Foot Disorders. Foot Ankle Clin. 2022;27(3):513-27.

15. Wukich DK, Johnson MJ, Raspovic KM. Limb Salvage in Severe Diabetic Foot Infection. Foot Ankle Clin. 2022;27(3):655-70.

16. Reiner MM, Khoury WE, Canales MB, Chmielewski RA, Patel K, Razzante MC, et al. Procalcitonin as a Biomarker for Predicting Amputation Level in Lower Extremity Infections. J Foot Ankle Surg. 2017;56(3):484-91.

17. Jeandrot A, Richard JL, Combescure C, Jourdan N, Finge S, Rodier M, et al. Serum procalcitonin and C‑reactive protein concentrations to distinguish mildly infected from non‑infected diabetic foot ulcers: a pilot study. Diabetologia. 2008;51(2):347-52.

18. Lavery LA, Ahn J, Ryan EC, Bhavan K, Oz OK, La Fontaine J, et al. What are the Optimal Cutoff Values for ESR and CRP to Diagnose Osteomyelitis in Patients with Diabetes‑related Foot Infections? Clin Orthop Relat Res. 2019;477(7):1594-602.

19. Zhang WQ, Tang W, Hu SQ, Fu XL, Wu H, Shen WQ, et al. C‑reactive protein and diabetic foot ulcer infections: A meta‑analysis. J Tissue Viability. 2022;31(3):537-43.

20. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Plast Reconstr Surg. 2006;117(7 Suppl):212S-38S.

21. Citron DM, Goldstein EJ, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate‑to‑severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol. 2007;45(9):2819-28.

22. Fejfarova V, Jirkovska A, Petkov V, Boucek P, Skibova J. Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot. J Diabetes Complications. 2004;18(2):108-12.

23. Mandell JC, Khurana B, Smith JT, Czuczman GJ, Ghazikhanian V, Smith SE. Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection. Emerg Radiol. 2018;25(2):175-88.

24. Giurato L, Meloni M, Izzo V, Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J Diabetes. 2017;8(4):135-42.

25. Chou YY, Hou CC, Wu CW, Huang DW, Tsai SL, Liu TH, et al. Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications. Int Wound J. 2022;19(6):1329-38.

26. Lam K, van Asten SA, Nguyen T, La Fontaine J, Lavery LA. Diagnostic Accuracy of Probe to Bone to Detect Osteomyelitis in the Diabetic Foot: A Systematic Review. Clin Infect, DiS. 2016;63(7):944-8.

27. Berendt AR, Peters EJ, Bakker K, Embil JM, Eneroth M, Hinchliffe RJ, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008;24 Suppl 1:S145-61.

28. Embil JM, Trepman E. Microbiological evaluation of diabetic foot osteomyelitis. Clin Infect, DiS. 2006;42(1):63-5.

29. Lavery LA, Sariaya M, Ashry H, Harkless LB. Microbiology of osteomyelitis in diabetic foot infections. J Foot Ankle Surg. 1995;34(1):61-4.

30. Lipsky BA, Berendt AR, Embil J, De Lalla F. Diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev. 2004;20 Suppl 1:S56-64.

31. Sella EJ, Grosser DM. Imaging modalities of the diabetic foot. Clin Podiatr Med Surg. 2003;20(4):729-40.

32. Berendt AR, Lipsky B. Is this bone infected or not? Differentiating neuro‑osteoarthropathy from osteomyelitis in the diabetic foot. Curr Diab Rep. 2004;4(6):424-9.

33. Zhan LX, Branco BC, Armstrong DG, Mills JL, Sr. The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. J Vasc Surg. 2015;61(4):939-44.

34. Ince P, Abbas ZG, Lutale JK, Basit A, Ali SM, Chohan F, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964-7.

35. Lavery LA, Ryan EC, Ahn J, Crisologo PA, Oz OK, La Fontaine J, et al. The Infected Diabetic Foot: Re‑evaluating the Infectious Diseases Society of America Diabetic Foot Infection Classification. Clin Infect, DiS. 2020;70(8):1573-9.

36. Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Off‑loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24(6):1019-22.

37. Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, et al. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3276.

38. Lipsky BA. Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection? Clin Microbiol Infect. 2007;13(4):351-3.

39. Uckay I, Berli M, Sendi P, Lipsky BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect, DiS. 2019;32(2):95-101.

40. Jeffcoate WJ. Osteomyelitis of the foot: non‑surgical management, SPECT/CT scanning and minimising the duration of antibiotic use. Diabetologia. 2017;60(12):2337-40.

41. Chatzipapas C, Karaglani M, Papanas N, Tilkeridis K, Drosos GI. Local Antibiotic Delivery Systems in Diabetic Foot Osteomyelitis: A Brief Review. Rev Diabet Stud. 2021;17(2):75-81.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#