From the Guidelines
Management of diabetic foot infections requires prompt, comprehensive treatment to prevent complications and limb loss, and should include wound assessment, debridement of necrotic tissue, appropriate antibiotic therapy, glycemic control, and offloading of pressure from the affected foot, as recommended by the most recent guidelines 1.
Key Components of Management
- Initial management should include wound assessment and debridement of necrotic tissue to promote healing and prevent further infection
- Appropriate antibiotic therapy should be selected based on the severity of the infection and the results of wound cultures, with options including oral antibiotics such as amoxicillin-clavulanate, cephalexin, or clindamycin for mild infections, and broader-spectrum antibiotics such as piperacillin-tazobactam, ertapenem, or vancomycin for moderate to severe infections
- Glycemic control is crucial to promote wound healing, with a target blood glucose range of 140-180 mg/dL during infection treatment
- Offloading devices such as total contact casts, removable cast walkers, or specialized footwear should be used to prevent further trauma to the affected foot ### Importance of Multidisciplinary Care
- Regular wound assessment and multidisciplinary care involving endocrinologists, infectious disease specialists, podiatrists, and vascular surgeons can improve outcomes and reduce the risk of complications
- Proper foot care education, including daily inspection, appropriate footwear, and prompt attention to new wounds, is crucial for preventing recurrent infections ### Diagnosis and Treatment of Complications
- Osteomyelitis, abscess, and sepsis are potential complications of diabetic foot infections, and require prompt diagnosis and treatment to prevent serious morbidity and mortality
- Imaging studies such as plain radiographs or magnetic resonance imaging may be helpful in diagnosing osteomyelitis, and surgical debridement or resection may be necessary to treat this condition
- Abscesses should be drained promptly, and sepsis should be treated with broad-spectrum antibiotics and supportive care as needed. The most recent guidelines from the IWGDF/IDSA 1 provide a comprehensive approach to the management of diabetic foot infections, and should be consulted for further guidance on diagnosis, treatment, and prevention of complications.
From the Research
Management of Diabetic Foot Infection
The management of diabetic foot infection (DFI) involves a multidisciplinary approach, including medical and surgical interventions. The following are key aspects of DFI management:
- Determining the severity of the infection to guide treatment 2, 3, 4, 5
- Identifying the type and extent of infection, as well as risk factors for resistant organisms 2, 4
- Using empiric antibiotics that cover gram-positive cocci for mild and moderate infections, and broad-spectrum antibiotics for severe infections or those caused by drug-resistant organisms 2, 6, 4, 5
- Definitive therapy should be based on culture reports and clinical response 2, 5
- Surgical interventions, such as debridement, resections, or revascularization, may be necessary depending on the severity of the wound 2, 4, 5
Diagnosis and Evaluation
Diagnosis of DFI involves:
- Clinical evaluation, including history, physical examination, and laboratory tests 2, 4, 5
- Imaging studies, such as plain radiographs or MRI, to evaluate bone infection and increase sensitivity and specificity 2, 5
- Culture specimens should be obtained before starting empirical antibiotic therapy, and tissue specimens are preferred over wound swab specimens 2
Treatment Strategies
Treatment strategies for DFI include:
- Antibiotic therapy, which should be continued until there is evidence that the infection has resolved 2
- Surgical interventions, such as debridement, resections, or revascularization, may be necessary depending on the severity of the wound 2, 4, 5
- Wound care, including proper wound cleansing, debridement of any callus and necrotic tissue, and off-loading of pressure 2, 5
- Multidisciplinary management approaches, including prevention, learning, regular foot assessment, aggressive intervention, and optimal use of therapeutic footwear, can help prevent exacerbation of the difficulty and eliminate the potential for amputation 5
Potential Complications
Potential complications of DFI include: