Managing diabetic foot infections: a review of the new guidelines

Foot infections are amongst the most frequent and severe complications linked to diabetes mellitus and are the most common non-traumatic cause of lower limb amputation. Appropriate management of these infections, however, can improve their outcome. The Infectious Diseases Society of America (IDSA) constituted a panel of multidisciplinary experts in 2004 to develop guidelines for the diagnosis and treatment of diabetic foot infections, which have been widely used and validated. Because there have been many new publications in the field, and the IDSA updated the format for all guidelines, they asked the diabetic foot infection committee to revise the 2004 publication. The revised guidelines, based on a thorough and systematic review of the literature, were published in 2012. They are built around 10 key questions concerning diagnosis and treatment; these are answered, with a summary of the evidence provided, and given a GRADE rating for the strength of the recommendation and quality of the evidence. The updated guidelines also include advice on implementing these recommendations, suggestions for regulatory changes to enhance care for diabetic foot infections, recommendations on performance measures and suggested areas for future research. They also include 14 tables, 1 figure, and 345 references, most of which were published after the first guidelines in 2004. Implementing these guidelines should improve outcomes in patients with a DFI.