New developments in diagnosing and treating diabetic foot infections

Abstract

Foot infections are common in persons with diabetes and are often the proximate cause of lower extremity amputation. There have been many publications in the past few years dealing with the appropriate ways to diagnose and treat diabetic foot infections. This review presents information gathered from a comprehensive, ongoing surveillance of the literature (published and abstracts) over the past 4 years. Prospective studies have now defined the epidemiology of diabetic foot infections, as well as methods to score and classify the wounds. Several recently published guidelines can assist clinicians in managing these infections. The etiologic agents of infection have been well-defined, and the prevalence of multi-drug-resistance pathogens is growing. Molecular methods offer great promise for quicker and more sensitive diagnosis of infection. New antimicrobial agents, both systemic and topical, as well as novel local treatments, have been shown to be effective in various studies. Improved methods of deploying older agents have added to the variety of treatment approaches now available. Several adjunctive treatments may benefit some patients but their role is as yet unclear. While there is much yet to learn about the most cost-effective ways to diagnose and treat diabetic foot infections the main effort is now to disseminate the available information and facilitate employing the evidence-based guideline recommendations.

Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

“…The large number of wounds infected with MRSA can be correlated with previous use of broad-spectrum antibiotics. 16 In the articles selected, the antibiotic treatments used were similar: clindamycin and amoxicillin/clavulanic acid were used in most of the studies. Tentolouris et al 6 and Dang et al 7 stated that specific antibiotic therapy for MRSA encouraged microbial resistance and was unnecessary since, according to these authors, MRSA could be eradicated by means of regular debridement, topical treatments and isolation in the foot clinic without the requirement for treatment with specific antibiotics (Table 2).…”

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

“…Our study showed that MDROs were common in hospitalized patients with chronic and acute wounds. An increase in the occurrence of chronic wound infections with MDROs in the diabetes mellitus population has been noted over the last decade and has been primarily attributed to MRSA, but antibioticresistant Gram-negative organisms, particularly Pseudomonas aeruginosa, have also been implicated (4) (29) . In our study, few patients underwent some type of amputation.…”

A pilot study to assess superficial versus deep tissue culture in acute wounds

“…6 Newer techniques for rapid identification of causative pathogens include the polymerase chain reaction (PCR) assay for organisms and the oligonucleotide assay for virulent gene identification for treating diabetic foot infections.…”