New Guidelines for Diabetic Foot Infections Can Help Prevent Amputations

New guidelines released for the diagnosis and treatment of diabetic foot infections (DFIs) include extensive, evidence-based answers determined to be most helpful for treatment decision-making,

The guidelines, developed by the Infectious Diseases Society of America (IDSA; Arlington, VA, USA), emphasize the need for rapid and more appropriate therapy to facilitate healing. Poor treatment of DFIs can lead to lower extremity amputation and about 50 percent of DFI patients who have foot amputations die within five years. About half of these amputations can be prevented by proper care.

“Lower extremity amputation takes a terrible toll on the diabetic patient,” said Benjamin A. Lipsky, MD, chair of the review panel, lead author of the guidelines, and professor of medicine. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation.”

Antibiotic therapy is often insufficient in the absence of proper wound care and surgical interventions, the guidelines note. Research since the 2004 IDSA guidelines has shown that many DFIs are treated improperly, including prescribing the wrong antibiotic or not addressing underlying conditions such as peripheral arterial disease. Since complications tend to occur, the best approach is to involve a multi-disciplinary team – including infectious diseases specialists, podiatrists, surgeons, and orthopedists – suggest the revised, updated guidelines. In rural areas, doctors may be able to use telemedicine to consult with the appropriate experts, Dr. Lipsky noted. Treating DFIs typically includes surgical removal (debridement) of dead tissue, appropriate antibiotic therapy and, if necessary, removing pressure on the wound and improving blood flow to the area.

The clinical practice guidelines, published online ahead of the June 2012, print edition of the journal Clinical Infectious Diseases, include 10 common questions with extensive, evidence-based answers. The first step is to determine if the wound is infected, which is likely if there are at least two of the following signs: redness, warmth, tenderness, pain, or swelling. Ulcers should not be automatically treated with antibiotics since about half are not infected. People with a severe infection should be hospitalized immediately. When a diabetic foot sore is infected, imaging the foot is usually necessary to determine if the bone is infected. It is also important to perform a culture of the wound to determine the bacteria causing the infection, though complex infections usually require broad-spectrum antibiotic regimens.

The guidelines are voluntary and not intended to take the place of a doctor’s judgment, but rather are recommendations to support the decision-making process individualized according to each patient’s circumstances. The full guidelines are available free on the IDSA website.

Related Links:
Infectious Diseases Society of America