Microdialysis as a tool for antibiotic assessment in patients with diabetic foot: a review

Abstract

Diabetic foot is a serious late complication frequently caused by infection and ischaemia. Both require prompt and aggressive treatment to avoid lower limb amputation. The effectiveness of peripheral arterial disease therapy can be easily verified using triplex ultrasound, ankle-brachial/toe-brachial index examination, or transcutaneous oxygen pressure. However, the success of infection treatment is difficult to establish in patients with diabetic foot. Intravenous systemic antibiotics are recommended for the treatment of infectious complications in patients with moderate or serious stages of infection. Antibiotic therapy should be initiated promptly and aggressively to achieve sufficient serum and peripheral antibiotic concentrations. Antibiotic serum levels are easily evaluated by pharmacokinetic assessment. However, antibiotic concentrations in peripheral tissues, especially in diabetic foot, are not routinely detectable. This review describes microdialysis techniques that have shown promise in determining antibiotic levels in the surroundings of diabetic foot lesions.

Does PAD and microcirculation status impact the tissue availability of intravenously administered antibiotics in patients with infected diabetic foot? Results of the DFIATIM substudy

“…The potential influence of PAD on the accessibility of time-dependent ATBs in the lower limbs has yet to be addressed in the literature. Microdialysis is the most suitable method for clearly determining tissue concentrations of ATBs, monitoring their pharmacokinetic and pharmacodynamic properties, and ensuring the efficacy of intravenous ATB administration in patients with infected DF and PAD ( 29 , 34 ). Before the introduction of microdialysis into clinical research, ATBs were detectable only in samples obtained from surgical resections or amputations, including even bone material ( 34 , 35 ).…”

“…The thawed clinical samples, ranging in volume between 15 - 20 μL, were mixed with three times the volume of acetonitrile as an organic solvent that serves to deproteinise the clinical sample and simultaneously suppresses its electrical conductivity. After centrifugation, the supernatant is immediately analyzed by CE-C 4 D; details are summarized in our recent publications ( 19 , 21 , 29 ).…”