Issues of infection related to diabetic foot syndrome
Authors:
MUDr. Milan Flekač, Ph.D.
Authors‘ workplace:
III. interní klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA
Published in:
Vnitř Lék 2015; 61(4): 328-334
Category:
Reviews
Overview
Foot wounds are common problem in people with diabetes and now constitute the most frequent diabetes-related cause of hospitalization. Diabetic foot infections cause substantial morbidity and at least one in five results in a lower extremity amputation. They are are now the predominant proximate trigger for lower extremity amputations worldwide. One in five diabetic wounds present clinical signs of infection at primomanifestation. About 80 % of limb non-threating wounds can be succesfully healed using appropriate and comprehensive approach, including antimicrobial therapy, revascularisation and off-loading.
Key words:
antimicrobial therapy – diabetic foot infection – diabetic foot syndrome – microbiological diagnostics – osteomyelitis
Sources
1. Spichler A, Hurwitz BL, Armstrong DG et al. Microbiology of diabetic foot infections: from Louis Pasteur to “crime scene investigation”. BMC Medicine 2015; 13: 2. Dostupné z DOI: <http://doi: 10.1186/s12916–014–0232–0>.
2. Lavery LA, Armstrong DG, Wunderlich RP et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006; 29(6): 1288–1293.
3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293(2): 217–228.
4. Prompers L, Schaper N, Apelqvist J et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease: The EURODIALE Study. Diabetologia 2008; 51(5): 747–755.
5. Lavery LA, Armstrong DG, Murdoch DP et al. Validation of the Infectious Diseases society of America’s diabetic foot infection classification system. Clin Infect Dis 2007; 44(4): 562–565.
6. Skrepnek GH, Armstrong DG, Mills JL. Open bypass and endovascular procedures among diabetic foot ulcer cases in the United States from 2001 to 2010. J Vasc Surg 2014; 60(5): 1255–1264.
7. Richard JL, Lavigne JP, Sotto A. Diabetes and foot infection: more than double trouble. Diabetes Metab Res Rev 2012; 28(Suppl 1): S46-S53.
8. Gardner SE, Frantz RA. Wound bioburden and infection-related complications in diabetic foot ulcers. Biol Res Nurs 2008; 10(1): 44–53.
9. Lipsky BA, Berendt AR, Cornia PB et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54(12): e132-e173.
10. Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. J Clin Invest 2007; 117(5): 1219–1222.
11. Richard JL, Sotto A, Lavigne JP. New insights in diabetic foot infection. World J Diabetes 2011; 2(2): 24–32.
12. Cutting KF, White R. Defined and refined: criteria for identifying wound infection revisited. Br J Community Nurs 2004; 9(3): S6-S15.
13. Gardner SE, Hillis SL, Frantz RA. Clinical signs of infection in diabetic foot ulcers with high microbial load. Biol Res Nurs 2009; 11(2): 119–128.
14. Xu L, McLennan SV, Lo L et al. Bacterial load predicts healing rate in neuropathic diabetic foot ulcers. Diabetes Care 2007; 30(2): 378–380.
15. Gardner SE, Haleem A, Jao YL et al. Cultures of diabetic foot ulcers without clinical signs of infection do not predict outcomes. Diabetes Care 2014; 37(10): 2693–2701.
16. Roberts AD, Simon GL. Diabetic foot infections: the role of microbiology and antibiotic treatment. Semin Vasc Surg 2012; 25(2): 75–81.
17. Uçkay I, Gariani K, Pataky Z et al. Diabetic foot infections: state-of the-art. Diabetes Obes Metab 2013; 16(4): 305–316.
18. Armstrong DG, Lavery LA, Nixon BP et al. It’s not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis 2004; 39(Suppl 2): S92-S99.
19. Lavigne JP, Sotto A, Dunyach-Remy C et al. New Molecular Techniques to Study the Skin Microbiota of Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2015; 4(1): 38–49.
20. Sotto A, Lina G, Richard JL et al. Virulence potential of Staphylococcus aureus strains isolated from diabetic foot ulcers: a new paradigm. Diabetes Care 2008; 31(12): 2318–2324.
21. Wolcott RD, Cox SB, Dowd SE. Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics. J Wound Care 2010; 19(7): 272–278.
22. Lipsky BA, Richard JL, Lavigne JP. Diabetic foot ulcer microbiome: one small step for molecular microbiology. One giant leap for understanding diabetic foot ulcers? Diabetes 2013; 62(3): 679–681.
23. Senneville E, Melliez H, Beltrand E et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 2006; 42(1): 57–62.
24. Senneville E, Morant H, Descamps D et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis 2009; 48(7): 888–893.
25. Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J 2004; 1(2): 123–132.
26. Lavery LA, Armstrong DG, Murdoch DP et al. Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect Dis 2007; 44(4): 562–565.
27. Jeandrot A, Richard JL, Combescure C et al. Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 2008; 51(2): 347–352.
28. Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep 2003; 3(6): 475–479.
29. Uzun G, Solmazgul E, Curuksulu H et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007; 213(4): 305–312.
30. Lipsky BA, Sheehan P, Armstrong DG et al. Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial. Int Wound J 2007; 4(1): 30–38.
31. Akinci B, Yener S, Yesil S et al. Acute phase reactants predict the risk of amputation in diabetic foot infection. J Am Podiatr Med Assoc 2011; 101(1): 1–6.
32. Syndrom diabetické nohy : mezinárodní konsenzus vypracovaný Mezinárodní pracovní skupinou pro syndrom diabetické nohy .Galén: Praha 2000. ISBN 80–7262–051–7.
33. Lipsky BA, Berendt AR, Deery HG et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2004; 39(7): 885–910.
34. Lipsky BA, Rerendt AR, Embil J et al. Diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev 2004; 20(Suppl 1): S56-S64.
35. Mason J, Keeffet CO, Hutschinson A et al. A systematic review of foot ulcer in patients with type 2 diabetes mellitus. II: treatment. Diabet Med 1999; 16(11): 889–909.
36. Caputo G, Cavanagh PR, Ulbrecht JS et al. Assessment and management of foot disease in patients with diabetes. N Eng J Med 1994; 331(13): 854–860.
37. Grayson ML, Gibbons GW, Balogh K et al. Probing to bone in infected pedal ulcers. JAMA 1995; 273(9): 721–723.
38. Dyet JF, Ettles DF, Nicholson AA et al. The role of radiology in the assesment and treatment of diabetic foot. In: Boulton AJM, Connor H, Cavanagh PR (eds). The foot in diabetes. 3rd ed. Wiley-Blackwell: Chichester 2000: 193–213. ISBN 978–0471489740.
39. Lew DP, Waldvogel FA. Osteomyelitis. N Eng J Med 1997; 336(14): 999–1007.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
![Issue 4](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/b372c09ef53516d17a92898f1fd37864.jpeg)
2015 Issue 4
Most read in this issue
- Myokines – muscle tissue hormones
- The treatment of diabetes in patients with liver and renal impairment
- Treatment of GLP1 receptor agonists and body mass control
- Treatment of hypertension in diabetes mellitus