Granulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections

Abstract

The available evidence is limited, but suggests that adjunctive G-CSF treatment in people with a diabetic foot infection, including infected ulcers, does not appear to increase the likelihood of resolution of infection or healing of the foot ulcer. However, it does appear to reduce the need for surgical interventions, especially amputations, and the duration of hospitalisation. Clinicians might consider adding G-CSF to the usual treatment of diabetic foot infections, especially in patients with a limb-threatening infection, but it is not clear which patients might benefit.

Impaired wound healing results from the dysfunction of the Akt/mTOR pathway in diabetic rats

“…At present, growth factors holds the greatest potential to change the situation of diabetic wound treatment [6,[9][10][11][39][40][41]. In diabetic wounds, a dramatic reduction in the levels of growth factors, such as GM-CSF [8,27], impedes repair and regeneration [6,9,11,[39][40][41][42][43][44][45]. Therefore, we observed the effect of the topical application of GM-CSF on diabetic wound healing.…”

G-CSF Administration Accelerates Cutaneous Wound Healing Accompanied With Increased Pro-Hyp Production In db/db Mice

“…These previous findings suggested the possible utility of additional G-CSF supplementation. Therefore, many interventional trials and double-blinded trials using G-CSF had been performed, especially for acute myocardial infarction and diabetic foot ulcers [15,16]. However, its effects are still controversial.…”

“…However, it is also known that G-CSF possesses a variety of functions, such as, endothelial-progenitor cell mobilization [10], stimulation of endothelial proliferation [11], mesenchymal stem cell mobilization [12], and augmentation of antibacterial function [13]. Since all these activities favor wound healing, many clinical studies of G-CSF have been conducted on refractory wounds in neutropenic patients [14], diabetic foot infections [15], and acute myocardial infarctions [16].…”

Colony-Stimulating Factors in the Prevention and Management of Infectious Diseases

“…60 Although G-CSF has been shown to significantly reduce the need for surgical interventions in nonneutropenic patients with diabetic foot infections, and to lead to a shorter duration of hospitalization when compared with standard therapy, it did not shorten either the time to resolution of infection or the duration of antibiotic therapy. 61 A separate systematic review focusing only on patients with diabetic foot infections complicated by osteomyelitis concluded that evidence was insufficient to recommend the routine use of G-CSFs. 62 Updated guidelines from the Infectious Diseases Society of America (IDSA) on the management of diabetic foot infections are expected in late 2011; however, the quality of the current evidence is not sufficiently high to recommend the routine use of G-CSFs in this patient population.…”