Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America., et al.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of Am.... Date of publication 2012 Jun 1;volume 54(12):e132-73.
1. Clin Infect Dis. 2012 Jun;54(12):e132-73. doi: 10.1093/cid/cis346.
2012 Infectious Diseases Society of America clinical practice guideline for the
diagnosis and treatment of diabetic foot infections.
Lipsky BA(1), Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG,
Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E; Infectious Diseases
Society of America.
Author information:
(1)Department of Medicine, University of Washington, Veterans Affairs Puget Sound
Health Care System, Seattle, WA, USA. balipsky@uw.edu
Republished in
J Am Podiatr Med Assoc. 2013 Jan-Feb;103(1):2-7.
Foot infections are a common and serious problem in persons with diabetes.
Diabetic foot infections (DFIs) typically begin in a wound, most often a
neuropathic ulceration. While all wounds are colonized with microorganisms, the
presence of infection is defined by ≥2 classic findings of inflammation or
purulence. Infections are then classified into mild (superficial and limited in
size and depth), moderate (deeper or more extensive), or severe (accompanied by
systemic signs or metabolic perturbations). This classification system, along
with a vascular assessment, helps determine which patients should be
hospitalized, which may require special imaging procedures or surgical
interventions, and which will require amputation. Most DFIs are polymicrobial,
with aerobic gram-positive cocci (GPC), and especially staphylococci, the most
common causative organisms. Aerobic gram-negative bacilli are frequently
copathogens in infections that are chronic or follow antibiotic treatment, and
obligate anaerobes may be copathogens in ischemic or necrotic wounds. Wounds
without evidence of soft tissue or bone infection do not require antibiotic
therapy. For infected wounds, obtain a post-debridement specimen (preferably of
tissue) for aerobic and anaerobic culture. Empiric antibiotic therapy can be
narrowly targeted at GPC in many acutely infected patients, but those at risk for
infection with antibiotic-resistant organisms or with chronic, previously
treated, or severe infections usually require broader spectrum regimens. Imaging
is helpful in most DFIs; plain radiographs may be sufficient, but magnetic
resonance imaging is far more sensitive and specific. Osteomyelitis occurs in
many diabetic patients with a foot wound and can be difficult to diagnose
(optimally defined by bone culture and histology) and treat (often requiring
surgical debridement or resection, and/or prolonged antibiotic therapy). Most
DFIs require some surgical intervention, ranging from minor (debridement) to
major (resection, amputation). Wounds must also be properly dressed and
off-loaded of pressure, and patients need regular follow-up. An ischemic foot may
require revascularization, and some nonresponding patients may benefit from
selected adjunctive measures. Employing multidisciplinary foot teams improves
outcomes. Clinicians and healthcare organizations should attempt to monitor, and
thereby improve, their outcomes and processes in caring for DFIs.
DOI: 10.1093/cid/cis346
PMID: 22619242 [Indexed for MEDLINE]
