Diabetic foot infections

Defined associated with any infection that is inframalleolar in a patients with diabetes.

Foot ulcerations are the most frequent diabetes related cause of admission to the hospital.

Accounts for almost half of all days spent in the hospital, and in developed countries are the leading cause of lower extremity amputations.

Yearly rate of foot infections is 36.5 per 1000 individuals with diabetes.

1/3 of patients hospitalized for a diabetic foot infection will require some form of amputation, and roughly, half who have a lowee limb amputation will die within five years.

A prospective study of diabetes patients revealed that during a 2-year follow-up period 9% developed a foot infection, and nearly all of these were precipitated by a foot wound.

Yearly rate of foot infections in diabetics is about 36.5 per 1000.

Most originate in skin ulcers with subsequent spread to soft tissues and bone.

Examination requires a probe to bone test, wound culture, and possible radiographic imaging with plain x-rays or MRI.

Successful care requires adequate wound care, surgical intervention and appropriate antibiotic management.

Antibiotic treatment is based on known or suspected pathogens associated with the infection.

Out patient acute wound infections are predominantly associated with aerobic gram-positive cocci.

Other infections are polymicrobial and involve gram-negative and anaerobic organisms.

Mild infections can usually be treated with oral antibiotics.

Moderate and severe infections require parenteral broad spectrum antibiotics.

Antibiotic management should be based on culture results and empiric treatment for superficial infections should treat Staphylococcus aureus and beta-hemolytic streptococci.

For moderate to severe infections broadening of the antibiotic coverage is needed to include Gram positive cocci, Gram negative bacilli and anaerobic organisms.

If a patient continues to have draining ulcers after appropriate antibiotic treatment, the presence of osteomyelitis must be considered and retained infected or necrotic tissue may be present.

Diagnosis of osteomyelitis in patients with diabetes challenging since classic signs and symptoms of infection may be subtle or missing by the coexistence of vascular disease and neuropathy.

The presence of peripheral neuropathy in patients with diabetes mellitus increases the risk of foot ulcers and diabetic foot infections 7 fold (Young MJ).

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