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The treatment of diabetic foot infections: focus on ertapenem
1Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK. michael.edmonds@kch.nhs.uk
Abstract:
Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram-negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.
Insights
Diabetic foot infections, ranging from localized to severe, require prompt diagnosis and aggressive antibiotic treatment. Multidisciplinary care, including surgery and metabolic control, is crucial for effective management and preventing complications like osteomyelitis.
Area of Science:
- Infectious Diseases
- Diabetology
- Bacteriology
Background:
- Diabetic foot infections present in three clinical stages: localized, spreading, and severe.
- These infections can be complicated by osteomyelitis and caused by various aerobic and anaerobic bacteria.
- Effective management requires prompt diagnosis, bacterial culture, and aggressive antibiotic therapy.
Purpose of the Study:
- To outline the principles of diagnosing and treating diabetic foot infections.
- To review current antibiotic treatment strategies and their efficacy.
- To emphasize the importance of a multidisciplinary approach.
Main Methods:
- Clinical staging of diabetic foot infections.
- Bacterial culturing and identification.
- Review of antibiotic treatment outcomes, including comparisons of different agents.
- Assessment of surgical and revascularization needs.
- Consideration of metabolic control in diabetes management.
Main Results:
- Localized infections with cellulitis may be managed with oral antibiotics as outpatients.
- Spreading infections necessitate systemic antibiotic treatment.
- Severe deep infections require hospitalization and broad-spectrum intravenous antibiotics.
- Clinical and microbiological responses to various antibiotics have shown similar rates, with no single agent proving universally superior.
- Ertapenem and piperacillin/tazobactam demonstrated equivalent clinical and microbiological outcomes in recent trials.
Conclusions:
- Diabetic foot infections require a comprehensive, multidisciplinary treatment strategy.
- Aggressive antibiotic therapy, tailored to infection severity and bacterial findings, is essential.
- Surgical intervention, revascularization for ischemic feet, and optimal metabolic control are critical components of care.
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