Outpatient Management of Uncomplicated Lower-Extremity Infections in Diabetic Patients

Classification of diabetic foot ulcers: Improving communication

“…Many, if not most, diabetic foot infections are not complicated by involvement of deep soft tissue or bone [15] and, hence, would be designated as stage 1 or 2 by our system. The dierence between stages 1 and 2 is disease progression; whether due to poor or inadequate wound care, noncompliance with weight-bearing recommendations, or worsening peripheral ischemia, it should be investigated.…”

“…For instance, it is possible that super®cial ulcerations may be treated with oral antibiotics from home, whereas those diabetics with deeper infections should have inpatient care and intravenous treatments. Clearly, the ®nancial savings of managing the infected diabetic foot from home are enormous [15] and deserve further prospective investigation.…”

“…It has been shown that if bone is palpated on probing, further roentgenographic and radionuclide tests to diagnose osteomyelitis are usually unnecessary, due to a speci®city of approximately 85% [8]. The sensitivity of this method, however, is somewhat lower (66%) [15], so that if high clinical suspicion persists, or for wounds of longer duration, the evaluation may require supplementation with a plain ®lm, bone scan, or magnetic resonance imaging (MRI) [1]. This is especially true for stage 3 ulcers, but also for lower-stage ulcers if physician experience so dictates.…”

Chapter 2-5-3c. Anaerobic infections (individual fields): skin and soft tissue infections––foot infection

“…In the presence of risk factors such as DM, antimicrobial agents (fluoroquinolones), exerting actions on aerobic Gram-positive cocci and aerobic Gram-negative bacilli, are administered [17].…”

Mikrobiologische Aspekte und rationelle antibiotische Therapie des diabetischen Fu�syndroms

“…Bei leichten Infektionen sind im Regelfall 1-2 Wochen Antibiokatherapie effektiv [58,69], während bei schweren Infektionen mit Knochenbeteiligung meist 3-6 Wochen bis mehrere Monate therapiert werden muss ( [51] und Tabelle 1). Bei der Bewertung bislang durchgeführter Studien ist zu berück-sichtigen, dass der Therapieerfolg aufgrund der hohen Rückfallquote grundsätzlich erst nach einem längeren Nachbeobachtungszeitraum (1-2 Jahre) beurteilt werden kann.…”