Diagnosis and Treatment of Diabetic Foot Infections

Lipsky, Benjamin A.; Berendt, Anthony R.; Deery, H. Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; LeFrock, Jack L.; Lew, Daniel Pablo; Mader, Jon T.; Norden, Carl W.; Tan, James S.

doi:10.1086/424846

Cited by 933 publications

(747 citation statements)

References 236 publications

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“…As noted in other studies [5,13], almost two-thirds of our patients with a foot infection were men, but men comprised just over one-half of the patients with non-foot infections. However, patients with a non-foot infection were more likely to have been recently hospitalised or to be residing in a skilled nursing facility, and were more severely ill on admission with higher rates of various physiological derangements.…”

Section: Discussionsupporting

confidence: 78%

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Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Tabak²,

et al. 2010

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Aims/hypothesis Skin and soft tissue infections (SSTIs) cause substantial morbidity in persons with diabetes. There are few data on pathogens or risk factors associated with important outcomes in diabetic patients hospitalised with SSTIs. Methods Using a clinical research database from CareFusion, we identified 3,030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007. We classified the culture isolates and analysed their association with the anatomic location of infection, mortality, length of stay and hospital costs. Results The only culture isolate with a significantly increased prevalence was methicillin-resistant Staphylococcus aureus (MRSA); prevalence for infection of the foot was increased from 11.6 to 21.9% (p<0.0001) and for non-foot locations from 14.0% to 24.6% (p=0.006). Patients with non-foot (vs foot) infections were more severely ill at presentation and had higher mortality rates (2.2% vs 1.0%, p<0.05). Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa (OR 3

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Section: Discussionsupporting

confidence: 78%

“…Various complications of diabetes (e.g. sensory neuropathy, vascular insufficiency, immunopathy and metabolic perturbations) can predispose these patients to infections [5,6]. SSTIs are more common and more severe in diabetic than in non-diabetic patients and constitute a leading cause of hospitalisation [7].…”

Section: Introductionmentioning

confidence: 99%

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Tabak²,

et al. 2010

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“…A complementary classification of the wound infection has been defined in the International Consensus on Diabetic Foot. 2 This classification consists of four grades [ Table 3]. …”

Section: Evaluation Of Diabetic Foot: Variations In Signs and Symptomsmentioning

confidence: 99%

Surgical revascularization techniques for diabetic foot

Kota¹,

Kota²,

Meher³

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tDiabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5e10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15e20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

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“…The diagnosis and treatment guidelines of the Infectious Diseases Society of America [27] recommend empirical treatment for 2-4 weeks. Radiographs of the foot are included in the pathway; however, if the patient is not sick enough to require hospitalization, no other imaging is recommended, even if the patient does not respond well to therapy.…”

mentioning

confidence: 99%

“…Radiographs of the foot are included in the pathway; however, if the patient is not sick enough to require hospitalization, no other imaging is recommended, even if the patient does not respond well to therapy. If the patient is very ill and requires hospitalization, then the guidelines state that advanced imaging such as CT, MRI, and bone scan should be considered, as these modalities may be helpful for surgical planning [27].…”

mentioning

confidence: 99%