Evaluation and Management of Diabetes-related Foot Infections

Cortés-Penfield, Nicolás W; Armstrong, David G.; Brennan, Meghan B.; Fayfman, Maya; Ryder, Jonathan H; Tan, Tze-Woei; Schechter, Marcos C.

doi:10.1093/cid/ciad255

Cited by 16 publications

(20 citation statements)

References 103 publications

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“…12 Infection and progressive gangrene are the primary causes of lower extremity amputation, 4 with approximately 50% of diabetic foot ulcers becoming infected. 7,13 Up to approximately 20% of people with a diabetic foot ulcer require hospitalization, and between 15% and 20% of hospitalized patients undergo a lower extremity amputation. 6,7,13 In the United States, more than 150 000 nontraumatic lower extremity amputations are performed every year in people with diabetes.…”

Section: Epidemiologymentioning

confidence: 99%

“…7,13 Up to approximately 20% of people with a diabetic foot ulcer require hospitalization, and between 15% and 20% of hospitalized patients undergo a lower extremity amputation. 6,7,13 In the United States, more than 150 000 nontraumatic lower extremity amputations are performed every year in people with diabetes. 11 Worldwide, approximately 1.6 million amputations occur each year.…”

Section: Epidemiologymentioning

confidence: 99%

“…7,13 Randomized clinical trial data are not available to support obtaining wound cultures from all patients with diabetic foot ulcers. 7,13 In the absence of other associated diagnoses, an erythrocyte sedimentation rate greater than 70 mm/h can be helpful in improving diagnostic accuracy for osteomyelitis (likelihood ratio, 11). 40,41 Particularly among hospitalized patients, for whom the pretest probability of osteomyelitis is high, the combination of a positive probe-to-bone test and plain film radiography can be sufficient to diagnose osteomyelitis (likelihood ratio, 14) without the need for other, more expensive radiological studies.…”

Section: Evaluating Infectionmentioning

confidence: 99%

“…7,43 For diagnosing osteomyelitis, bone biopsy and culture remain the gold standard. 7,13 Evaluating Peripheral Artery Disease…”

Section: Evaluating Infectionmentioning

confidence: 99%

“…About 20% of people with a diabetic foot ulcer will undergo a lower extremity amputation, either minor (ie, part of the foot) or major (ie, above foot) . Infection and progressive gangrene are the primary causes of lower extremity amputation, with approximately 50% of diabetic foot ulcers becoming infected . Up to approximately 20% of people with a diabetic foot ulcer require hospitalization, and between 15% and 20% of hospitalized patients undergo a lower extremity amputation .…”

Section: Epidemiologymentioning

confidence: 99%

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Diabetic Foot Ulcers

Armstrong

Tan

Boulton

et al. 2023

JAMA

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182

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ImportanceApproximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year, including 1.6 million people in the United States. These ulcers precede 80% of lower extremity amputations among people diagnosed with diabetes and are associated with an increased risk of death.ObservationsNeurological, vascular, and biomechanical factors contribute to diabetic foot ulceration. Approximately 50% to 60% of ulcers become infected, and about 20% of moderate to severe infections lead to lower extremity amputations. The 5-year mortality rate for individuals with a diabetic foot ulcer is approximately 30%, exceeding 70% for those with a major amputation. The mortality rate for people with diabetic foot ulcers is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcers. People who are Black, Hispanic, or Native American and people with low socioeconomic status have higher rates of diabetic foot ulcer and subsequent amputation compared with White people. Classifying ulcers based on the degree of tissue loss, ischemia, and infection can help identify risk of limb-threatening disease. Several interventions reduce risk of ulcers compared with usual care, such as pressure-relieving footwear (13.3% vs 25.4%; relative risk, 0.49; 95% CI, 0.28-0.84), foot skin measurements with off-loading when hot spots (ie, greater than 2 °C difference between the affected foot and the unaffected foot) are found (18.7% vs 30.8%; relative risk, 0.51; 95% CI, 0.31-0.84), and treatment of preulcer signs. Surgical debridement, reducing pressure from weight bearing on the ulcer, and treating lower extremity ischemia and foot infection are first-line therapies for diabetic foot ulcers. Randomized clinical trials support treatments to accelerate wound healing and culture-directed oral antibiotics for localized osteomyelitis. Multidisciplinary care, typically consisting of podiatrists, infectious disease specialists, and vascular surgeons, in close collaboration with primary care clinicians, is associated with lower major amputation rates relative to usual care (3.2% vs 4.4%; odds ratio, 0.40; 95% CI, 0.32-0.51). Approximately 30% to 40% of diabetic foot ulcers heal at 12 weeks, and recurrence after healing is estimated to be 42% at 1 year and 65% at 5 years.Conclusions and RelevanceDiabetic foot ulcers affect approximately 18.6 million people worldwide each year and are associated with increased rates of amputation and death. Surgical debridement, reducing pressure from weight bearing, treating lower extremity ischemia and foot infection, and early referral for multidisciplinary care are first-line therapies for diabetic foot ulcers.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Evaluating Infectionmentioning

confidence: 99%

“…7,43 For diagnosing osteomyelitis, bone biopsy and culture remain the gold standard. 7,13 Evaluating Peripheral Artery Disease…”

Section: Evaluating Infectionmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Diabetic Foot Ulcers

Armstrong

Tan

Boulton

et al. 2023

JAMA

Self Cite

182

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Ten common misconceptions about antibiotic use in the hospital

Lam,

Bourassa‐Blanchette

2023

Journal of Hospital Medicine

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Antimicrobials are one of the most administered medications in hospitals. Thoughtful and rational antibiotic prescribing by clinicians are important in reducing the adverse effects to both the host that takes the antibiotic and also the individuals in the host's community. Principles informing antibiotic prescribing in the hospital are commonly rooted in misconceptions. We review 10 common myths associated with antibacterial usage in hospitalized patients and share contemporary evidence in hopes of enhancing evidence‐informed practice in this patient care setting.

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