Anti-infective therapy for foot ulcers in patients with diabetes

Foot infection is a huge economic and social burden for patients with diabetes. The etiology is multifactorial, necessitating a multidisciplinary team for successful treatment and prevention. Infection usually is a consequence rather than the cause of foot ulcers in patients with diabetes. Infection is a clinical diagnosis and can be categorized as mild cellulitis, moderate to severe cellulitis, and osteomyelitis. No single imaging technique is 100% sensitive or specific for the diagnosis of osteomyelitis. Infected foot ulcers require appropriate tissue and bone cultures to guide antibiotic therapy whereas uninfected ulcers, which may be colonized with bacteria, do not require antibiotics. Gram-positive organisms account for a substantial proportion of infections with increasing prevalence of methicillin-resistant Staphylococcus aureus in recent years. Osteomyelitis in patients with diabetes requires aggressive surgical intervention in addition to antibiotics. Duration of treatment varies from 2 to 6 weeks based on the severity of infection, along with surgical debridement. Prevention of foot ulcer and infection requires patient education, detection of neuropathy, glycemic control, and proper foot care with foot hygiene and appropriate footwear. The patient is an important member of the team and should be taught the importance of self examination and early reporting of foot problems.