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The diabetic foot. Soft tissue and bone infection
B A Lipsky1, R E Pecoraro, L J Wheat
1Department of Medicine, University of Washington School of Medicine, Seattle.
Infectious Disease Clinics of North America
|September 1, 1990
Summary
Diabetic foot infections require accurate microbial diagnosis from tissue cultures. Prompt treatment with appropriate antibiotics, considering infection severity and microbial patterns, is crucial for managing these complex conditions.
Area of Science:
- Infectious Diseases
- Diabetology
- Podiatry
Background:
- Diabetic patients face high risks of foot infections due to neurological, vascular, and metabolic issues.
- Soft tissue and bone infections in the feet are common complications of diabetes.
Purpose of the Study:
- To outline the microbial causes of diabetic foot infections.
- To recommend optimal diagnostic methods for these infections.
- To guide antibiotic treatment strategies for diabetic foot infections.
Main Methods:
- Microbial cultures from tissue curettage or aspiration for soft tissue infections.
- Analysis of common pathogens, including aerobic gram-positive cocci, gram-negative bacilli, and anaerobes.
- Radiological and nuclear medicine scans for bone infections, with emphasis on culture confirmation.
Main Results:
- Aerobic gram-positive cocci are primary pathogens, often with accompanying gram-negative bacilli or anaerobes in chronic cases.
- Tissue cultures are superior to swabs for determining microbial etiology.
- Imaging for bone infections can be inaccurate, highlighting the need for bone cultures.
Conclusions:
- Accurate diagnosis of diabetic foot infections relies on appropriate tissue and bone cultures.
- Treatment varies from oral antibiotics for mild outpatient cases to broad-spectrum parenteral antibiotics for severe infections.
- Understanding microbial patterns is key to effective management of diabetic foot complications.