Diagnosing and treating diabetic foot infections

Abstract

Foot infections are a common, complex and costly complication of diabetes. We have made considerable progress in establishing consensus definitions for defining infection. Similarly, we have learned much about the appropriate ways to diagnose both soft tissue and bone infections. Accompanying these advances have been improvements in our knowledge of the proper approaches to antibiotic (and surgical) therapy for diabetic foot infections. Furthermore, investigators have explored the value of various adjunctive therapies, especially granulocyte colony stimulating factors and hyperbaric oxygen, for improving outcomes. This paper presents a summary of a minisymposium on infection of the diabetic foot that was held at the fourth International Symposium on the Diabetic Foot, in Noordwijkerhout, The Netherlands.

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 .…”

“…Possible infection signs are: fever, chills, hypotension, anorexia, nausea, vomiting, change in mental status and hyperglycaemic state and blood abnormalities such as leukocytosis, elevated sedimentation rate, CRP or procalcitonin levels or positive blood cultures are further signs of a severe infection. Nevertheless in more than 50% of patients with diabetes and infectious DFS these signs were absent [64] . Different classification systems developed in the last years for the stadiation of diabetic foot infections, but a widely accepted method is the IDSA classification scheme, with four progressive levels of infection and with a good correlation with clinical findings [65,66] .…”

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

“…This is due, at least in part, to their painless nature in patients with peripheral sensory neuropathy [71] and the fact that most nonsevere diabetic foot infections do not produce systemic manifestations such as fever or leucocytosis [72]. A culture of swabs collected from ulcers and other foot lesions in diabetic patients often yields several pathogens that can be difficult to distinguish from colonising organisms, especially in chronic or previously treated wounds [73].…”

The Diabetic Foot—Imaging Options and Considerations

“…Radiographs can detect cortical fragmentation, osteomyelitis, fractures, arterial calcifications, and soft-tissue gas and articular deformities, including Charcot osteoarthropathy (see Figure 1). 1,4 While radiography is often used initially, an early diagnosis of osteomyelitis may be difficult to make as changes on radiographs are often subtle, or absent, in the early stages of the disease process. 5 Thus, this imaging modality is useful for detecting changes associated with the later stages of osseous infection (typically two or more weeks from onset) (see Figure 2).…”