Diagnosis and Treatment of Diabetic Foot Infections

Lipsky, Benjamin A.; Berendt, Anthony R.; Deery, H. Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; LeFrock, Jack L.; Lew, Daniel Pablo; Mader, Jon T.; Norden, Carl W.; Tan, James S.

doi:10.7547/0950183

Cited by 86 publications

(124 citation statements)

References 217 publications

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“…DFI is best managed by a dedicated team via appropriate consultations [3,27,28]. Patients with severe infections or ischaemia should be hospitalized and closely monitored [4,21] and this was carried out in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetic wound infection is the most common cause of hospitalization in diatetic patients [1,2]. Severe diabetic foot infections (DFIs) lead to extremity amputations, reduced quality of life and mortality [3][4][5][6][7]. In addition to proper local wound care, DFIs require carefully selected antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Parenteral administration is usually preferred to achieve rapidly an adequate tissue concentration, particularly for moderate to severe DFI. Antibiotics such as ampicillinsulbactam, piperacillin-tazobactam (Pip-Tazo), imipenemcilastatin (IMP) or ertapenem are usually recommended for moderate to severe cases [3,4,[6][7][8][9][10][11]. Although the efficacy of these agents is well-established in DFI, Pip-Tazo and IMP have not been compared head-to-head with each other before, particulary in patients with DFI associated with osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

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Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital

Saltoğlu

Dalkiran

Tetıker

et al. 2010

Clinical Microbiology and Infection

123

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In this prospective, randomized, open-label clinical trial, we compared the efficacy and safety of two antibiotic regimens for severe diabetic foot infections (DFI). Sixty-two in-patients with DFI received either piperacillin/tazobactam (Pip-Tazo, n = 30) (4.5 g intravenously every 8h) or imipenem/cilastatin (IMP, n = 32) (0.5 g intravenously every 6h). The mean duration of treatment was 21 days for Pip-Tazo and 24 days for IMP. Twenty-two (73.3%) patients in the Pip-Tazo group and 26 (81.2%) patients in the IMP group had DFI associated with osteomyelitis. Successful clinical response was seen in 14 (46.7%) patients in the Pip-Tazo group and in nine (28.1%) patients in the IMP group [relative risk (RR) 1.6 (95% CI 0.84-3.25), p 0.130]. Two patients in the IMP group and none in the PIP-Tazo group relapsed [RR 2 (0.94-4.24), p 0.058]. Eighty-nine microorganisms were isolated: 38 (43%) Gram-positive and 51(57%) Gram-negative. Among patients with positive culture, 47 (96%) had complete and two (4%) had partial microbiological response. Microbiological response rates were similar in both groups (p 1.000). Amputation was performed in 18 (60%) and 22 (69%) patients in the Pip-Tazo and IMP groups (p 0.739) respectively. Side effects were more common in the Pip-Tazo group (30% vs. 9.4%), but they were generally mild and reversible. In conclusion, although the sample size was small and the results did not reach statistical significance, Pip-Tazo produced a better clinical response rate than IMP in the treatment of severe DFI. There was no significant difference between the treatment groups with respect to microbiological response, relapse and amputation rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital

Saltoğlu

Dalkiran

Tetıker

et al. 2010

Clinical Microbiology and Infection

123

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“…Increased plantar pressure, especially beneath the metatarsal heads, and the resultant callus play an important role. Callus may result in an excess plantar pressure, which emphasizes the importance of early and mild chemical debridement of the hyperkeratotic tissue with keratolytics 91 . The patients often already have xerosis of the plantar skin with scales, fissures, erosions and impaired barrier function, complicating the situation.…”

Section: Diabetic Foot Syndromementioning

confidence: 99%

Juvenile, insulin‐dependent diabetes mellitus, type 1‐related dermatoses

Sehgal¹,

Bhattacharya²,

Verma³

2010

Acad Dermatol Venereol

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Juvenile insulin-dependent diabetes mellitus type 1 (IDDM) is a well-recognized worldwide entity, the significance of which has increased because of its recent upsurging trends, warranting attention on variety of its clinical expressions, in particular, pertaining to skin, an aspect seldom taken cognizance of. Hence an endeavour to recap the related dermatoses, such as limited joint mobility syndrome including sclerodermoid (scleroderma-like) changes, xerosis, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot syndrome, has been made. Complexities relating to the recently explored issues of atopic dermatitis and drug hypersensitivity syndrome have also been covered adequately. In addition, the current concepts of the physiopathology of type 1 diabetes-related dermatoses are briefly recapitulated for clarity.

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“…Infection is an extremely important component of impaired wound healing in the diabetic foot [32]. Whilst it has been shown that the risk of infection is the same for patients with good glycemic control as those with poor glycemic control [33], anecdotal evidence suggests that the spread of infection is more rapid in those with poor glycemic control (HbA1c >10%).…”

Section: Management Of a Foot Ulcermentioning

confidence: 99%

Improving wound-healing outcomes in diabetic foot ulcers

McLennan

McGill

Twigg

et al. 2007

Expert Review of Endocrinology & Metabolism

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The prevalence of diabetes is increasing worldwide and has been forecasted to double in the next 20 years. The major increase in morbidity and mortality of diabetes is due to the development of both macro-and microvascular complications, including failure of the wound-healing process. Foot ulcers occur in 15% of all patients with diabetes and precede 84% of all lower-leg amputations. The essential components of diabetic foot ulcer treatment are to reduce foot bearing pressure (in neuropathic ulcers) and to increase blood supply (in the case of vascular ulcers). Antibacterial therapy is also important. Despite optimized treatment, for reasons not completely understood, some ulcers fail to heal. Previous research studies have shown clearly that failure of healing eventually leads to deep-seated infection and amputation. Therefore, impaired wound healing is the pivotal event responsible for most of the morbidity (and mortality) of diabetic foot disease. Improving wound healing in diabetes requires a multidisciplinary approach in terms of clinical management as well as an increased effort aimed at better understanding the pathogenesis of poor wound healing in diabetes. Consequently, a detailed understanding of the wound-healing process in diabetes and how it can be improved is of great importance. However, efforts to develop new therapies are hampered by a lack of knowledge of the molecular mechanisms responsible for the pathologies, as well as a lack of suitable models for the study of chronic wounds. Therefore, this review will address both clinical and biochemical aspects of wound healing in diabetes.

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Diagnosis and Treatment of Diabetic Foot Infections

Cited by 86 publications

References 217 publications

Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital

Piperacillin/tazobactam versus imipenem/cilastatin for severe diabetic foot infections: a prospective, randomized clinical trial in a university hospital

Juvenile, insulin‐dependent diabetes mellitus, type 1‐related dermatoses

Improving wound-healing outcomes in diabetic foot ulcers

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