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Management of diabetic foot infections in an era of increasing microbial resistance

Sandra Bliss Nelson1

  • 1Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, GRJ-504, Boston, MA 02114, USA. sbnelson@partners.org

Current Infectious Disease Reports
|August 25, 2009
PubMed

Insights

Diabetic foot infections are a serious complication, often caused by resistant bacteria. Effective management requires a multimodal approach including advanced antimicrobial therapies for better patient outcomes.

Area of Science:

  • Infectious Diseases
  • Diabetology
  • Podiatry

Background:

  • Diabetic foot infections (DFIs) lead to significant morbidity, high costs, and potential amputation.
  • Increasing prevalence of resistant organisms like methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative bacteria complicates treatment.
  • DFIs necessitate comprehensive management beyond antibiotics.

Purpose of the Study:

  • To outline the optimal, multimodal management strategies for diabetic foot infections.
  • To highlight the role of targeted antimicrobial therapy in the context of rising antimicrobial resistance.
  • To discuss emerging therapeutic options for DFIs.

Main Methods:

  • Review of current literature on diabetic foot infection management.
  • Analysis of the impact of antimicrobial resistance on treatment choices.
  • Emphasis on integrated care including wound care, biomechanics, and vascular assessment.

Main Results:

  • Optimal DFI management is multimodal, integrating antimicrobial therapy with biomechanical support, wound care, glycemic control, and vascular assessment.
  • Antimicrobial selection must consider infection severity, depth, and likely pathogens, informed by reliable deep cultures.
  • Newer antimicrobial agents show promise against resistant gram-positive and gram-negative organisms in DFIs.

Conclusions:

  • Multimodal management is crucial for effectively treating diabetic foot infections.
  • Targeted antimicrobial therapy, guided by culture data and considering resistance patterns, is essential.
  • Advancements in antimicrobial agents offer new hope for managing complex and resistant DFIs.

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