Diagnostic and Therapeutic Approaches in Diabetic Foot Infections

Abstract

Diabetic foot infections (DFI) are the major cause of non-traumatic amputations of lower extremities. Important predisposing factors for the development of DFI are peripheral neuropathy and diabetic angiopathy. The most common pathogen isolated in early DFI is Staphylococcus aureus. Chronic long-lasting lesions accompanied by severe ischemia of lower extremities usually have polymicrobial etiology. In patients with long-term antimicrobial therapy there is a high probability of multiresistant pathogens. The main purpose of the treatment of DFI is to save the foot and its functions. Antimicrobial therapy, in parallel with surgical procedures, is an important method of treatment of DFI. The choice of antimicrobials should be based on microbiological results, local data on antimicrobial resistance and clinical response on empirically administered therapy. Duration of antimicrobial therapy depends on the severity of infection, adequacy of surgical procedures, and the degree of vascular insufficiency. Surgical treatment is essential in the presence of deep abscess, phlegmon, bones/joints destruction, and severe ischemia.