Antibiotic selection for diabetic foot infections: a review

Foot infections account for about 20% of all hospitalizations in people with diabetes and at least 50% of all nontraumatic lower-limb amputations performed annually in the United States. As many as 25% of all diabetics are expected to develop severe foot problems at some point in their lifetimes. Diabetic foot infections are generally more severe and more difficult to treat than infections in nondiabetics. This is due to impaired microvascular circulation, neuropathy, anatomical alterations, and impaired immune capacity in diabetic patients. Most moderate-to-severe soft-tissue diabetic foot infections are polymicrobial (i.e., due to gram-positive, gram-negative, aerobic, and anaerobic pathogens). Empiric antibiotic therapy should include broad-spectrum antibiotics capable of covering the most common pathogens found in diabetic infections. Other factors to consider in antibiotic selection include the severity of the infection, the presence of peripheral vascular disease, and the possibility of drug-resistant organisms in the infection. This review summarizes the clinical presentation and antimicrobial therapy of diabetic foot infections.