A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot

E. J G Peters, B. A. Lipsky, A. R. Berendt, J. M. Embil, L. A. Lavery, E. Senneville, V. Urbančič-Rovan, K. Bakker, W. J. Jeffcoate

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

The International Working Group on the Diabetic Foot expert panel on infection conducted a systematic review of the published evidence relating to treatment of foot infection in diabetes. Our search of the literature published prior to August 2010 identified 7517 articles, 29 of which fulfilled predefined criteria for detailed data extraction. Four additional eligible papers were identified from other sources. Of the total of 33 studies, 29 were randomized controlled trials, and four were cohort studies. Among 12 studies comparing different antibiotic regimens in the management of skin and soft-tissue infection, none reported a better response with any particular regimen. Of seven studies that compared antibiotic regimens in patients with infection involving both soft tissue and bone, one reported a better clinical outcome in those treated with cefoxitin compared with ampicillin/sulbactam, but the others reported no differences between treatment regimens. In two health economic analyses, there was a small saving using one regimen versus another. No published data support the superiority of any particular route of delivery of systemic antibiotics or clarify the optimal duration of antibiotic therapy in either soft-tissue infection or osteomyelitis. In one non-randomized cohort study, the outcome of treatment of osteomyelitis was better when the antibiotic choice was based on culture of bone specimens as opposed to wound swabs, but this study was not randomized, and the results may have been affected by confounding factors. Results from two studies suggested that early surgical intervention was associated with a significant reduction in major amputation, but the methodological quality of both was low. In two studies, the use of superoxidized water was associated with a better outcome than soap or povidone iodine, but both had a high risk of bias. Studies using granulocyte-colony stimulating factor reported mixed results. There was no improvement in infection outcomes associated with hyperbaric oxygen therapy. No benefit has been reported with any other intervention, and, overall, there are currently no trial data to justify the adoption of any particular therapeutic approach in diabetic patients with infection of either soft tissue or bone of the foot.

Original languageEnglish (US)
Pages (from-to)142-162
Number of pages21
JournalDiabetes/Metabolism Research and Reviews
Volume28
Issue numberSUPPL. 1
DOIs
StatePublished - Feb 2012

Fingerprint

Diabetic Foot
Soft Tissue Infections
Anti-Bacterial Agents
Infection
Osteomyelitis
Cohort Studies
Foot Bones
Povidone-Iodine
Bone and Bones
Cefoxitin
Soaps
Hyperbaric Oxygenation
Granulocyte Colony-Stimulating Factor
Therapeutics
Amputation
Foot
Randomized Controlled Trials
Economics
Skin
Health

Keywords

  • Antibiotics
  • Diabetes mellitus
  • Diabetic foot
  • Infection
  • Osteomyelitis
  • Surgery
  • Systematic review

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Peters, E. J. G., Lipsky, B. A., Berendt, A. R., Embil, J. M., Lavery, L. A., Senneville, E., ... Jeffcoate, W. J. (2012). A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes/Metabolism Research and Reviews, 28(SUPPL. 1), 142-162. https://doi.org/10.1002/dmrr.2247

A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. / Peters, E. J G; Lipsky, B. A.; Berendt, A. R.; Embil, J. M.; Lavery, L. A.; Senneville, E.; Urbančič-Rovan, V.; Bakker, K.; Jeffcoate, W. J.

In: Diabetes/Metabolism Research and Reviews, Vol. 28, No. SUPPL. 1, 02.2012, p. 142-162.

Research output: Contribution to journalArticle

Peters, EJG, Lipsky, BA, Berendt, AR, Embil, JM, Lavery, LA, Senneville, E, Urbančič-Rovan, V, Bakker, K & Jeffcoate, WJ 2012, 'A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot', Diabetes/Metabolism Research and Reviews, vol. 28, no. SUPPL. 1, pp. 142-162. https://doi.org/10.1002/dmrr.2247
Peters, E. J G ; Lipsky, B. A. ; Berendt, A. R. ; Embil, J. M. ; Lavery, L. A. ; Senneville, E. ; Urbančič-Rovan, V. ; Bakker, K. ; Jeffcoate, W. J. / A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. In: Diabetes/Metabolism Research and Reviews. 2012 ; Vol. 28, No. SUPPL. 1. pp. 142-162.
@article{23db81cbbbf848f5b49ab5efad528f00,
title = "A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot",
abstract = "The International Working Group on the Diabetic Foot expert panel on infection conducted a systematic review of the published evidence relating to treatment of foot infection in diabetes. Our search of the literature published prior to August 2010 identified 7517 articles, 29 of which fulfilled predefined criteria for detailed data extraction. Four additional eligible papers were identified from other sources. Of the total of 33 studies, 29 were randomized controlled trials, and four were cohort studies. Among 12 studies comparing different antibiotic regimens in the management of skin and soft-tissue infection, none reported a better response with any particular regimen. Of seven studies that compared antibiotic regimens in patients with infection involving both soft tissue and bone, one reported a better clinical outcome in those treated with cefoxitin compared with ampicillin/sulbactam, but the others reported no differences between treatment regimens. In two health economic analyses, there was a small saving using one regimen versus another. No published data support the superiority of any particular route of delivery of systemic antibiotics or clarify the optimal duration of antibiotic therapy in either soft-tissue infection or osteomyelitis. In one non-randomized cohort study, the outcome of treatment of osteomyelitis was better when the antibiotic choice was based on culture of bone specimens as opposed to wound swabs, but this study was not randomized, and the results may have been affected by confounding factors. Results from two studies suggested that early surgical intervention was associated with a significant reduction in major amputation, but the methodological quality of both was low. In two studies, the use of superoxidized water was associated with a better outcome than soap or povidone iodine, but both had a high risk of bias. Studies using granulocyte-colony stimulating factor reported mixed results. There was no improvement in infection outcomes associated with hyperbaric oxygen therapy. No benefit has been reported with any other intervention, and, overall, there are currently no trial data to justify the adoption of any particular therapeutic approach in diabetic patients with infection of either soft tissue or bone of the foot.",
keywords = "Antibiotics, Diabetes mellitus, Diabetic foot, Infection, Osteomyelitis, Surgery, Systematic review",
author = "Peters, {E. J G} and Lipsky, {B. A.} and Berendt, {A. R.} and Embil, {J. M.} and Lavery, {L. A.} and E. Senneville and V. Urbančič-Rovan and K. Bakker and Jeffcoate, {W. J.}",
year = "2012",
month = "2",
doi = "10.1002/dmrr.2247",
language = "English (US)",
volume = "28",
pages = "142--162",
journal = "Diabetes/Metabolism Research and Reviews",
issn = "1520-7552",
publisher = "John Wiley and Sons Ltd",
number = "SUPPL. 1",

}

TY - JOUR

T1 - A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot

AU - Peters, E. J G

AU - Lipsky, B. A.

AU - Berendt, A. R.

AU - Embil, J. M.

AU - Lavery, L. A.

AU - Senneville, E.

AU - Urbančič-Rovan, V.

AU - Bakker, K.

AU - Jeffcoate, W. J.

PY - 2012/2

Y1 - 2012/2

N2 - The International Working Group on the Diabetic Foot expert panel on infection conducted a systematic review of the published evidence relating to treatment of foot infection in diabetes. Our search of the literature published prior to August 2010 identified 7517 articles, 29 of which fulfilled predefined criteria for detailed data extraction. Four additional eligible papers were identified from other sources. Of the total of 33 studies, 29 were randomized controlled trials, and four were cohort studies. Among 12 studies comparing different antibiotic regimens in the management of skin and soft-tissue infection, none reported a better response with any particular regimen. Of seven studies that compared antibiotic regimens in patients with infection involving both soft tissue and bone, one reported a better clinical outcome in those treated with cefoxitin compared with ampicillin/sulbactam, but the others reported no differences between treatment regimens. In two health economic analyses, there was a small saving using one regimen versus another. No published data support the superiority of any particular route of delivery of systemic antibiotics or clarify the optimal duration of antibiotic therapy in either soft-tissue infection or osteomyelitis. In one non-randomized cohort study, the outcome of treatment of osteomyelitis was better when the antibiotic choice was based on culture of bone specimens as opposed to wound swabs, but this study was not randomized, and the results may have been affected by confounding factors. Results from two studies suggested that early surgical intervention was associated with a significant reduction in major amputation, but the methodological quality of both was low. In two studies, the use of superoxidized water was associated with a better outcome than soap or povidone iodine, but both had a high risk of bias. Studies using granulocyte-colony stimulating factor reported mixed results. There was no improvement in infection outcomes associated with hyperbaric oxygen therapy. No benefit has been reported with any other intervention, and, overall, there are currently no trial data to justify the adoption of any particular therapeutic approach in diabetic patients with infection of either soft tissue or bone of the foot.

AB - The International Working Group on the Diabetic Foot expert panel on infection conducted a systematic review of the published evidence relating to treatment of foot infection in diabetes. Our search of the literature published prior to August 2010 identified 7517 articles, 29 of which fulfilled predefined criteria for detailed data extraction. Four additional eligible papers were identified from other sources. Of the total of 33 studies, 29 were randomized controlled trials, and four were cohort studies. Among 12 studies comparing different antibiotic regimens in the management of skin and soft-tissue infection, none reported a better response with any particular regimen. Of seven studies that compared antibiotic regimens in patients with infection involving both soft tissue and bone, one reported a better clinical outcome in those treated with cefoxitin compared with ampicillin/sulbactam, but the others reported no differences between treatment regimens. In two health economic analyses, there was a small saving using one regimen versus another. No published data support the superiority of any particular route of delivery of systemic antibiotics or clarify the optimal duration of antibiotic therapy in either soft-tissue infection or osteomyelitis. In one non-randomized cohort study, the outcome of treatment of osteomyelitis was better when the antibiotic choice was based on culture of bone specimens as opposed to wound swabs, but this study was not randomized, and the results may have been affected by confounding factors. Results from two studies suggested that early surgical intervention was associated with a significant reduction in major amputation, but the methodological quality of both was low. In two studies, the use of superoxidized water was associated with a better outcome than soap or povidone iodine, but both had a high risk of bias. Studies using granulocyte-colony stimulating factor reported mixed results. There was no improvement in infection outcomes associated with hyperbaric oxygen therapy. No benefit has been reported with any other intervention, and, overall, there are currently no trial data to justify the adoption of any particular therapeutic approach in diabetic patients with infection of either soft tissue or bone of the foot.

KW - Antibiotics

KW - Diabetes mellitus

KW - Diabetic foot

KW - Infection

KW - Osteomyelitis

KW - Surgery

KW - Systematic review

UR - http://www.scopus.com/inward/record.url?scp=84856192063&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856192063&partnerID=8YFLogxK

U2 - 10.1002/dmrr.2247

DO - 10.1002/dmrr.2247

M3 - Article

C2 - 22271738

AN - SCOPUS:84856192063

VL - 28

SP - 142

EP - 162

JO - Diabetes/Metabolism Research and Reviews

JF - Diabetes/Metabolism Research and Reviews

SN - 1520-7552

IS - SUPPL. 1

ER -