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Medical condition
Diabetic foot infection
Gas gangrene due to diabetes
Symptoms
Pus from a wound, redness, swelling, pain, warmth[1]
Complications
Infection of the bone, tissue death, sepsis, amputation[2]
Causes
Diabetic foot ulcer[2]
Diagnostic method
Based on symptoms[1]
Differential diagnosis
Phlegmasia cerulea dolens, ischemic limb[2]
Prevention
Appropriate shoes[2]
Treatment
Wound care, antibiotics, hyperbaric oxygen therapy[2]
Frequency
Common[2]
Diabetic foot infection is any infection of the foot in a diabetic person.[3] The most frequent cause of hospitalization for diabetic patients is due to foot infections.[4] Symptoms may include pus from a wound, redness, swelling, pain, warmth, tachycardia, or tachypnea.[5] Complications can include infection of the bone, tissue death, amputation, or sepsis.[3] They are common and occur equally frequently in males and females. Older people are more commonly affected.
They most often form following a diabetic foot ulcer, though not all foot ulcers become infected. Diabetic foot ulcers can be caused by vascular disease or neuropathy and its prevalence occurs in approximately 25% of diabetics throughout their lifetime.[5] Some risk factors for developing diabetic foot infections include history of repeated foot ulcers, foot ulcers lasting for longer than 30 days, poor control over blood glucose levels, peripheral neuropathy, renal impairment, peripheral artery disease, injury or trauma to foot, walking barefoot frequently, and history of amputation in lower limbs.[5][6][7] Most diabetic foot infections are polymicrobial (contain multiple infective organisms), and bacteria that are commonly involved include staphylococcus, including methicillin resistant staphylococcus aureus (MRSA), streptococci, pseudomonas, and gram-negative bacteria.[3][6] Previously, MRSA infections were usually acquired from hospital settings, however, recently MRSA infections acquired from the community are becoming more prevalent and are linked to poor treatment outcomes for diabetic patients.[7] Some risk factors for developing MRSA infections include use of antibiotics that cover a broad spectrum of pathogens for a long duration of time, prolonged hospital stay, or certain surgical procedures.[7] The underlying mechanism of diabetic foot infections often involves poor blood flow and peripheral neuropathy. Diagnosis is based on symptoms and may be supported by deep tissue culture.[3]
Treatment involves proper wound care and antibiotics. Pseudomonas aeruginosa empiric therapy is not warranted unless the patient had a previous infection with a culture identifying the organism, or if the patient has risk factors for it such as frequent use of wet dressings or living in hot climates.[6][5] MRSA empiric therapy is also not warranted unless the patient has a critical infection such as sepsis, if the rate of MRSA infections are particularly high in a local area, or if the patient had a previous MRSA infection.[6] The duration of antibiotics depends on the severity of infection, ranging anywhere from 1–12 weeks. Treatment of mild-moderate infections should last 1–2 weeks and typically requires oral antibiotics that cover staphylococci and streptococci.[5] Severe infections typically require IV antibiotics that cover more pathogens, such as gram positive organisms, gram negative organisms, and obligate anaerobes to allow for better treatment outcomes.[5] Total antibiotic treatment of severe infections should be approximately 2–3 weeks or more, depending on how extensive the infection is.[6] Prevention includes wearing appropriate shoes, regular foot examinations, and control of risk factors.
^ abLipsky, Benjamin A.; Berendt, Anthony R.; Deery, H. Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; LeFrock, Jack L.; Lew, Daniel P.; Mader, Jon T.; Norden, Carl; Tan, James S. (1 October 2004). "Diagnosis and Treatment of Diabetic Foot Infections". Clinical Infectious Diseases. 39 (7): 885–910. doi:10.1086/424846. PMID 15472838. S2CID 19826519.
^Gleckman, R. A.; Roth, R. M. (February 1985). "Diabetic foot infections--prevention and treatment". The Western Journal of Medicine. 142 (2): 263–265. ISSN 0093-0415. PMC 1306006. PMID 4013261.
^ abcdefNoor, Saba; Khan, Rizwan Ullah; Ahmad, Jamal (April 2017). "Understanding Diabetic Foot Infection and its Management". Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 11 (2): 149–156. doi:10.1016/j.dsx.2016.06.023. PMID 27377687.
^ abcdeLipsky, Benjamin A.; Berendt, Anthony R.; Cornia, Paul B.; Pile, James C.; Peters, Edgar J. G.; Armstrong, David G.; Deery, H. Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; Pinzur, Michael S. (2012-06-15). "2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infectionsa". Clinical Infectious Diseases. 54 (12): e132–e173. doi:10.1093/cid/cis346. ISSN 1537-6591. PMID 22619242.
^ abcLipsky, Benjamin A.; Berendt, Anthony R.; Deery, H Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; LeFrock, Jack L.; Lew, Daniel P.; Mader, Jon T.; Norden, Carl; Tan, James S. (June 2006). "Diagnosis and Treatment of Diabetic Foot Infections". Plastic and Reconstructive Surgery. 117 (SUPPLEMENT): 212S–238S. doi:10.1097/01.prs.0000222737.09322.77. ISSN 0032-1052. PMID 16799390. S2CID 8275000.
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outside, infection may follow. Infection may also lead to ulceration. This process can be prevented at several places. Diabeticfootinfections are the...
loss of sensation (see diabeticfoot). Small infections can progress to ulceration and this may require amputation. Globally diabetic neuropathy affects approximately...
organ transplant. Diabetics have vascular and nerve impairment, and are at risk of cellulitis, a potentially serious bacterial infection; any relatively...
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disease, and infections, especially in the legs, so socks and footwear that reduce or eliminate pressures or hot spots is important. A diabetic sock is a...
pettenkoferi was identified as the cause of osteomyelitis in a diabeticfootinfection in France. Trülzsch K, Grabein B, Schumann P, Mellmann A, Antonenka...
complicated skin and skin structure infections, complicated intra-abdominal infections and diabeticfootinfection. Increased mortality was in comparison...
especially important part of the treatment for diabetic ulcers, which may create the need for amputation if infection gets out of control. Mechanical removal...
Diabetic osteolysis Bone resorption Diabeticfoot ulcers should be treated via the VIPs—vascular management, infection management and prevention, and pressure...
dysfunction). Loss of pain sensation predisposes to trauma that can lead to diabeticfoot problems (such as ulceration), the most common cause of non-traumatic...
Harkless LB (May 1998). "Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation"....
off of the foot (off-loading) in patients with diabeticfoot ulcers (DFUs). Reducing pressure on the wound by taking weight off the foot has proven to...
A.; Joseph, Warren S. (July 2007). "Update on the Treatment of DiabeticFootInfections". Clinics in Podiatric Medicine and Surgery. 24 (3): 383–396. doi:10...
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