A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot

Abstract

Summary The International Working Group on the Diabetic Foot expert panel on infection conducted a systematic review of the published evidence relating to treatment of foot infection in diabetes. Our search of the literature published prior to August 2010 identified 7517 articles, 29 of which fulfilled predefined criteria for detailed data extraction. Four additional eligible papers were identified from other sources. Of the total of 33 studies, 29 were randomized controlled trials, and four were cohort studies. Among 12 studies comparing different antibiotic regimens in the management of skin and soft‐tissue infection, none reported a better response with any particular regimen. Of seven studies that compared antibiotic regimens in patients with infection involving both soft tissue and bone, one reported a better clinical outcome in those treated with cefoxitin compared with ampicillin/sulbactam, but the others reported no differences between treatment regimens. In two health economic analyses, there was a small saving using one regimen versus another. No published data support the superiority of any particular route of delivery of systemic antibiotics or clarify the optimal duration of antibiotic therapy in either soft‐tissue infection or osteomyelitis. In one non‐randomized cohort study, the outcome of treatment of osteomyelitis was better when the antibiotic choice was based on culture of bone specimens as opposed to wound swabs, but this study was not randomized, and the results may have been affected by confounding factors. Results from two studies suggested that early surgical intervention was associated with a significant reduction in major amputation, but the methodological quality of both was low. In two studies, the use of superoxidized water was associated with a better outcome than soap or povidone iodine, but both had a high risk of bias. Studies using granulocyte‐colony stimulating factor reported mixed results. There was no improvement in infection outcomes associated with hyperbaric oxygen therapy. No benefit has been reported with any other intervention, and, overall, there are currently no trial data to justify the adoption of any particular therapeutic approach in diabetic patients with infection of either soft tissue or bone of the foot. Copyright © 2012 John Wiley & Sons, Ltd.

Diagnosis, Treatment and Prevention of Diabetic Foot Wounds and Infections: Turkish Consensus Report

“…Kemik Biyopsisi: Kemik biyopsisi var olan tanı yöntem-leri içinde kemik infeksiyonunun histopatolojik tanısında olduğu kadar, infeksiyon etkeninin ve antibiyotik duyarlılığı-nın saptanmasında ve tedavinin belirlenmesinde en geçerli yöntemdir (45)(46)(47). Kemik dokusunun kültüründe üreme olmasının, osteomyelit tanısında yüksek bir duyarlılık (%92) ve özgüllüğe (%60) sahip olduğu gösterilmiştir (48).…”

Seeking effective interventions to treat complex wounds: an overview of systematic reviews

“…Three systematic reviews including four meta-analyses [24,35,57] and 10 systematic reviews without a meta-analysis [69,70,74,79,81,86,88,93,98,112] (Table 4 ; Additional files 4 and 6) examined healing improvements of diabetic foot/leg ulcers. Three had an AMSTAR score ≥8 [24,74,98].…”

Management of Hospitalized Patients with Diabetic Foot Infections

“…58 Based on the results of the treatment studies of DFIs, no single antibiotic or combination of agents appears to be superior to the others. 7,16,17,59 The clinical response to antibiotic therapy and the result of appropriate wound culture are the most important factors in choosing the potentially most effective regimen.…”