Expert opinion on the management of infections in the diabetic foot

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

Research output: Contribution to journalReview articlepeer-review

137 Scopus citations

Abstract

This update of the International Working Group on the Diabetic Foot incorporates some information from a related review of diabetic foot osteomyelitis (DFO) and a systematic review of the management of infection of the diabetic foot. The pathophysiology of these infections is now well understood, and there is a validated system for classifying the severity of infections based on their clinical findings. Diagnosing osteomyelitis remains difficult, but several recent publications have clarified the role of clinical, laboratory and imaging tests. Magnetic resonance imaging has emerged as the most accurate means of diagnosing bone infection, but bone biopsy for culture and histopathology remains the criterion standard. Determining the organisms responsible for a diabetic foot infection via culture of appropriately collected tissue specimens enables clinicians to make optimal antibiotic choices based on culture and sensitivity results. In addition to culture-directed antibiotic therapy, most infections require some surgical intervention, ranging from minor debridement to major resection, amputation or revascularization. Clinicians must also provide proper wound care to ensure healing of the wound. Various adjunctive therapies may benefit some patients, but the data supporting them are weak. If properly treated, most diabetic foot infections can be cured. Providers practising in developing countries, and their patients, face especially challenging situations.

Original languageEnglish (US)
Pages (from-to)163-178
Number of pages16
JournalDiabetes/Metabolism Research and Reviews
Volume28
Issue numberSUPPL. 1
DOIs
StatePublished - Feb 2012

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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