From the Guidelines
The most common infection in patients with Diabetes Mellitus (DM) is a diabetic foot infection (DFI), which usually arises from a skin ulceration due to peripheral neuropathy or trauma. Diabetics are particularly susceptible to DFIs due to several factors, including:
- High blood sugar levels creating an ideal environment for bacterial growth in the wound
- Reduced immune function in diabetics making it harder to fight off infections
- Nerve damage (neuropathy) affecting sensation and mobility, leading to increased infection risk To prevent DFIs, diabetics should:
- Maintain good blood sugar control
- Practice proper foot care, including regular washing and drying
- Wear appropriate footwear to reduce trauma
- Monitor for signs of infection, such as redness, swelling, or increased pain If a DFI is suspected, seek medical attention promptly. Treatment typically involves a course of antibiotics, such as those recommended by the Infectious Diseases Society of America (IDSA) 1. The specific antibiotic and duration may vary based on individual factors and local resistance patterns. It's crucial to complete the entire course of antibiotics as prescribed, even if symptoms improve, to prevent recurrence and antibiotic resistance. Additionally, a multidisciplinary approach to care, including wound care, debridement, pressure off-loading, and vascular or surgical interventions, can improve outcomes and reduce the risk of amputation 1.
From the Research
Infections in Patients with Diabetes Mellitus (DM)
- Diabetic foot infections are the most common complication of diabetes mellitus leading to hospitalization and the most frequent cause of nontraumatic lower extremity amputation 2.
- Foot infections occur in approximately 40% of diabetes-related foot ulcers and cause significant morbidity 3.
- The most common pathogens in diabetic foot infections are aerobic gram-positive cocci, mainly Staphylococcus species 2, with Staphylococcus aureus being a significant pathogen 4.
Classification and Diagnosis of Diabetic Foot Infections
- Diabetic foot infections are classified as mild, moderate, or severe based on the presence of at least two classic findings of inflammation or purulence 2.
- Diagnosis is based on clinical signs and symptoms of local inflammation, and imaging studies are indicated for suspected deep soft tissue purulent collections or osteomyelitis 5.
- Superficial wound cultures should be avoided due to the high rate of contaminants, and deep cultures obtained through aseptic procedures help guide treatment 3.
Treatment of Diabetic Foot Infections
- Treatment is based on the extent and severity of the infection and comorbid conditions, and may include oral or intravenous antibiotics, wound care, and pressure off-loading 2.
- Mild infections can be treated with oral antibiotics, while severe infections require intravenous antibiotics and possible surgical intervention 5, 2.
- Antibiotic therapy should cover commonly isolated organisms and reflect local resistance patterns, patient preference, and the severity of the foot infection 3.