Ilker Uçkay1, Javier Aragón-Sánchez2, Daniel Lew3, Benjamin A Lipsky4. 1. Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Electronic address: ilker.uckay@hcuge.ch. 2. Diabetic Foot Unit, Service of Surgery, La Paloma Hospital, Las Palmas de Gran Canaria, Spain. 3. Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland. 4. Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Medical Sciences, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Infection is a common epiphenomenon of advanced diabetic foot disease and the most common reason for diabetes-related hospitalizations and lower extremity amputations. Major advances have been made in the past three decades in our understanding and management of diabetic foot infections (DFIs). The optimal treatment of DFIs clearly involves multidisciplinary input. METHODS: A comprehensive search of the literature on DFIs from January 1960 through June 2015 was performed, with an emphasis on information published in the past 30 years. RESULTS: There have been many new insights into the microbiology, diagnosis, and treatment of DFIs, although the implementation of this knowledge in clinical practice has been suboptimal. Today, the use of evidence-based guidelines, multidisciplinary teams, and institution-specific clinical pathways helps guide optimal care of this multifaceted problem. Patients are more often treated in the ambulatory setting, with antibiotic regimens that are more targeted, oral and shorter course, and with more conservative (but earlier) surgical interventions. New diagnostic and therapeutic methods are being developed at an accelerating pace. CONCLUSIONS: The worldwide increase in the incidence of diabetes and longer lifespan of diabetic patients will undoubtedly increase the incidence of DFIs. Clinicians caring for diabetic patients should have an understanding of current methods for preventing, diagnosing, and treating DFIs.
BACKGROUND: Infection is a common epiphenomenon of advanced diabetic foot disease and the most common reason for diabetes-related hospitalizations and lower extremity amputations. Major advances have been made in the past three decades in our understanding and management of diabetic foot infections (DFIs). The optimal treatment of DFIs clearly involves multidisciplinary input. METHODS: A comprehensive search of the literature on DFIs from January 1960 through June 2015 was performed, with an emphasis on information published in the past 30 years. RESULTS: There have been many new insights into the microbiology, diagnosis, and treatment of DFIs, although the implementation of this knowledge in clinical practice has been suboptimal. Today, the use of evidence-based guidelines, multidisciplinary teams, and institution-specific clinical pathways helps guide optimal care of this multifaceted problem. Patients are more often treated in the ambulatory setting, with antibiotic regimens that are more targeted, oral and shorter course, and with more conservative (but earlier) surgical interventions. New diagnostic and therapeutic methods are being developed at an accelerating pace. CONCLUSIONS: The worldwide increase in the incidence of diabetes and longer lifespan of diabeticpatients will undoubtedly increase the incidence of DFIs. Clinicians caring for diabeticpatients should have an understanding of current methods for preventing, diagnosing, and treating DFIs.
Authors: Roger V Ortines; Haiyun Liu; Lily I Cheng; Taylor S Cohen; Heather Lawlor; Abhishek Gami; Yu Wang; Carly A Dillen; Nathan K Archer; Robert J Miller; Alyssa G Ashbaugh; Bret L Pinsker; Mark C Marchitto; Christine Tkaczyk; C Kendall Stover; Bret R Sellman; Lloyd S Miller Journal: Antimicrob Agents Chemother Date: 2018-02-23 Impact factor: 5.191