Diabetic foot infection: Antibiotic therapy and good practice recommendations

Barwell, N. J.; Devers, Marion; Kennon, Brian; Hopkinson, Helen; McDougall, Claire; Young, Matthew J.; Robertson, Hannah M A; Stang, Duncan; Dancer, S.J.; Seaton, Andrew; Leese, Graham

doi:10.1111/ijcp.13006

Cited by 70 publications

(61 citation statements)

References 104 publications

(148 reference statements)

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“…Conversely, several have shown antibiotics do penetrate into soft tissue in diabetic patients, but this depends on the antibiotic tested [52][53][54]. Peripheral arterial disease (PAD) is a known risk factor in chronic, non-healing wounds because of reduced oxygenation and immune involvement at the site of infection [55,56], however studies of antibiotic concentrations in DFIs have frequently excluded those with PAD [57] and so the concentration of antibiotics reaching tissue in these patients may be even lower.…”

Section: Discussionmentioning

confidence: 99%

Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro

et al. 2020

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Diabetic foot ulcers can become chronic and non-healing despite systemic antibiotic treatment. The penetration of systematically-administered antibiotics to the site of infection is uncertain, as is the effectiveness of such levels against polymicrobial biofilms. We have developed an in vitro model to study the effectiveness of different treatments for infected diabetic foot ulcers in a wound-like environment and compared the activity of systemic levels of antibiotics with that for topically applied antibiotics released from calcium sulfate beads. This is the first study that has harvested bacteria from diabetic foot infections and recreated similar polymicrobial biofilms to those present in vivo for individual subjects. After treatment with levels of gentamicin attained in serum after systemic administration (higher than corresponding tissues concentrations) we measured a 0-2 log reduction in bacterial viability of P. aeruginosa, S. aureus or a polymicrobial biofilm. Conversely, addition of gentamicin loaded calcium sulfate beads resulted in 5-9 log reductions in P. aeruginosa, S aureus and polymicrobial biofilms derived from three subjects. We conclude that systemically administered antibiotics are likely to be inadequate for successfully treating these infections, especially given the vastly increased concentrations required to inhibit cells in a biofilm, and that topical antibiotics provide a more effective alternative. OPEN ACCESSCitation: Price BL, Morley R, Bowling FL, Lovering AM, Dobson CB (2020) Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro. PLoS ONE 15(2): e0228704. https://doi.org/10.

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Section: Discussionmentioning

confidence: 99%

Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro

et al. 2020

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“…Fortunately, almost all patents with a mild infection, and many with a moderate infection, can be treated in an ambulatory setting. Most published studies of DFIs have enrolled hospitalized patients, but over the past two decades, several have reported good results with outpatient treatment . The IDSA/IWGDF classification scheme was not designed to help determine when an infection has resolved (ie, the absence of signs and symptoms that were used to diagnose infection), but it makes sense that it could be used this way and has been in some studies of antibiotic therapy for DFIs.…”

Section: Diagnosismentioning

confidence: 99%

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

524

729

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

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“…9 To avoid antibacterial resistance and other adverse outcome of therapy, it is best practice that treatment of clinical diabetic foot infections be completed with narrow spectrum antibiotics for the shortest duration possible. 22 …”

Section: Treatment Of Active Infectionmentioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

588

403

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Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

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Diabetic foot infection: Antibiotic therapy and good practice recommendations

Cited by 70 publications

References 104 publications

Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro

Susceptibility of monomicrobial or polymicrobial biofilms derived from infected diabetic foot ulcers to topical or systemic antibiotics in vitro

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Update on management of diabetic foot ulcers

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