Diabetic foot infections: state‐of‐the‐art

Abstract

Foot infections are frequent and potentially devastating complications of diabetes. Unchecked, infection can progress contiguously to involve the deeper soft tissues and ultimately the bone. Foot ulcers in people with diabetes are most often the consequence of one or more of the following: peripheral sensory neuropathy, motor neuropathy and gait disorders, peripheral arterial insufficiency or immunological impairments. Infection develops in over half of foot ulcers and is the factor that most often leads to lower extremity amputation. These amputations are associated with substantial morbidity, reduced quality of life and major financial costs. Most infections can be successfully treated with optimal wound care, antibiotic therapy and surgical procedures. Employing evidence-based guidelines, multidisciplinary teams and institution-specific clinical pathways provides the best approach to guide clinicians through this multifaceted problem. All clinicians regularly seeing people with diabetes should have an understanding of how to prevent, diagnose and treat foot infections, which requires familiarity with the pathophysiology of the problem and the literature supporting currently recommended care.

Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

“…Adiponectin has been also reported by recent studies as involved in the regulation of inflammatory vascular response by reducing the expression of adhesion molecules on endothelial cells [62] , impairing endothelial cell NF-κB-related mechanisms [45] and altering macrophage actions [64] . A recent research also reported how adiponectin inhibits the TNF-α related expression of E-selectin, VCAM-1and ICAM-1 in human endothelial cells [46] thus indicating how adiponectin has been evaluated as real vasoprotective and anti-atherogenic factor .…”

“…In a recent study [62,63] enrolling patients with DFS, infections increased the risk of a minor amputation by 50% compared to patients without infection. Among factors able to predispose to infections on diabetic foot it's possible to include: foot ulcer duration of longer than 30 d, a history of recurrent foot ulcers, traumatic causes, peripheral vascular disease and neuropathy.…”

Staphylococcus aureus-Associated Musculoskeletal Infections

“…This form, referred to as diabetic foot infection (Wagner 1981), is due to microvascular, macrovascular, and/or neuropathic changes, which are commonly observed in but not restricted to patients with diabetes mellitus (Lew and Waldvogel 2004). This form, which is characterized by specific pathogenesis, microbial spectrum, and treatment modalities (Waldvogel et al 1970b), has recently been reviewed elsewhere (Uckay et al 2014(Uckay et al , 2015 and is beyond the scope of this work. In the context of differential diagnosis, the Charcot arthropathy has to be taken into account.…”

The role of anaerobes in diabetic foot infections

“…Additional contributing factors in DFI include impairment in arterial blood supply, metabolic effects of chronic hyperglycemia, and poorly understood types of immune dysfunction [6]. When there is a break in the protective skin envelope, bacteria will contaminate then colonize the exposed subcutaneous tissues.…”