Diabetic Foot Infections: The Diagnostic Challenges

Lauri, Chiara; Leone, Alessandro; Cavallini, Marco; Signore, Alberto; Giurato, Laura; Uccioli, Luigi

doi:10.3390/jcm9061779

Cited by 36 publications

(48 citation statements)

References 96 publications

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“…Patients usually need to be hospitalised for a long time or repeatedly in a specific period of time because of the symptom exacerbations; additionally, they need to take long-term medications for diabetes and complications. The treatment of infections in DFU should be done after identification of the pathogen and analysing the susceptibility to antibiotics, and a correct diagnostic is established [51,52]. Costs related to microbiological testing are variable with the method used, confirmation of a strain with a resistance phenotype, therapeutic options, etc.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

et al. 2020

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Background and objectives: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, being related to frequent and long-term hospitalisation, reduced quality of life of the patient, amputations, a high rate of morbidity and mortality. The bacterial aetiology is complex, sometimes involving more than one pathogen, playing a major role in the infection prognosis and development of microbial resistance. This study evaluated the current state of the aetiology, clinical and pathological characteristics of DFU in a single diabetes centre in order to provide some specific measures to prevent it. Materials and Methods: This retrospective study was conducted on patients with diabetes mellitus (252 individuals diagnosed with DFU) between January 2018–December 2019. All participants were assessed based on their clinical characteristics, including complications of diabetes and pathological and microbiological evaluations. Results: The present research revealed that diabetic foot ulcer prevalence was higher in males than in females and higher in type 2 diabetic patients than in type 1 diabetic patients. The patients with diabetic foot ulcer were older, had a higher body mass index (BMI), longer diabetic duration and had more diabetic complications, such as retinopathy, diabetic polyneuropathy and diabetic kidney disease, than patients without diabetic foot ulceration. Conclusions: Taking into account all factors involved, including the aetiology and the antibiotic susceptibility pattern of these isolates, planning the suitable treatment options of patients is possible.

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Section: Discussionmentioning

confidence: 99%

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

et al. 2020

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“…35 They found that although blood cell scintigraphy appears to be the most reliable imaging modality for differentiating osteomyelitis, soft tissue infection, and Charcot in patients with suspected DFI, both FDG and WBC have significantly higher specificity than MRI. 28…”

Section: Comparison With Wbc Scintigraphymentioning

confidence: 99%

Update on functional imaging in the evaluation of diabetic foot infection

Iyengar

Jain

Mohamed

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Diabetic foot infection is a preventable complication of diabetes mellitus. It is an essential component of diabetic foot disease, which is characterised by a triad of neuropathy, ischaemia and infection. These factors may lead to foot ulceration, sepsis and amputation resulting in increased morbidity and poor quality of life. Confirming or excluding infection can be difficult especially when routine laboratory tests and plain radiographs are inconclusive. Early diagnosis and localization of diabetic foot infection is extremely important to institute timely, appropriate therapy. Structural imaging using computed tomography and magnetic resonance imaging all have individual applications towards the diagnostic workup of this condition but have their own limitations. Scintigraphic detection is based on physiochemical changes and hence provides a functional evaluation of bone pathology.We describe the evolution of functional nuclear medicine imaging including immunoscintigraphy in diabetic foot infection and highlight current applications of physiological 18-Fluoro-deoxyglucose positron emission tomography (18-FDG-PET) and computed tomography (18-FDG-PET/CT) in such patients.18-FDG-PET/CT is a promising modality for imaging diabetic foot infection. Future studies will allow standardisation of technological details and options of 18-FDG-PET/CT interpretation in diabetic foot infection.

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“…Charcot osteoarthropathy, with or without a superimposed infection, is another foot complication of diabetes that further complicates the diagnosis. Indeed, the most important diagnostic challenge is to differentiate between these three conditions since they require very different therapeutic approaches [17]. In case of OM, it is also important to correctly evaluate the extent of the infection and of affected bones.…”

Section: Role Of [ 18 F]fdg Pet/ct In Diabetic Foot Infectionsmentioning

confidence: 99%

“…Plain X-ray film usually represents the first step imaging modality since it provides an anatomical overview of the foot and detects any pre-existing condition that should be known for the correct interpretation of second level imaging modalities. Despite the specificity for detecting an infection is low, MRI is the radiologic modality of choice for the study of DFI since it provides high quality images with high definition between soft tissues and bone, being able to achieve the diagnosis of infection with a good accuracy [17]. From a nuclear medicine point of view, the gold standard imaging modality for diagnosis of infective complications of DF, still remains radiolabeled white blood cell (WBC) scintigraphy [20][21][22][23], especially if performed following EANM recommendations [20,24,25], as also demonstrated in previous meta-analysis [26] and by a large retrospective study comparing radiolabeled WBC scintigraphy, [ 18 F]FDG PET/CT and MRI [23].…”

Section: Role Of [ 18 F]fdg Pet/ct In Diabetic Foot Infectionsmentioning

confidence: 99%

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State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

Casali

Lauri

Altini

et al. 2021

Clin Transl Imaging

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103

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Aim The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [ 18 F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. Methods In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [ 18 F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [ 18 F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. Results Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and

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Diabetic Foot Infections: The Diagnostic Challenges

Cited by 36 publications

References 96 publications

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

Update on functional imaging in the evaluation of diabetic foot infection

State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation

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