Abstract

Persons with diabetes often develop foot wounds, which frequently become infected. Infections typically involve soft tissues at first, but can spread to underlying bone. These infections cause considerable morbidity and are often the proximate cause of lower extremity amputation. Many studies in the past few years have improved knowledge of the most appropriate ways to diagnose and treat diabetic foot infections. This review presents information gathered from a comprehensive, ongoing surveillance of the literature (published and abstracts) over the past 5 years. Prospective studies have now defined the epidemiology of diabetic foot infections, as well as validated methods to score and classify the wounds. Several recently published guidelines can assist clinicians in managing these infections. The etiologic agents of infection have been well-defined, and these can be anticipated by epidemiological and clinical clues. Of particular concern is that the prevalence of multidrug-resistance pathogens (especially methicillin-resistant Staphylococcus aureus) is growing. Molecular methods offer great promise for quicker and more sensitive diagnosis of infection. New antimicrobial agents, both systemic and topical, as well as novel local treatments, have been shown to be effective in various studies. Improved methods of deploying older agents have added to the variety of treatment approaches now available. Several adjunctive treatments may benefit some patients but their role is as yet unclear. Recent analyses have provided guidance on managing diabetic foot osteomyelitis. While there is much yet to learn about how to most cost-effectively diagnose and treat diabetic foot infections the main effort is now to disseminate the available information and facilitate employing the evidence-based guideline recommendations.