An updated IDSA guideline for the diagnosis and treatment of diabetic foot infections is now available online. It also appears in the June 15 issue of Clinical Infectious Diseases.
The guideline is a revision and update of IDSA’s 2004 diabetic foot infections guideline. Research since then has proven that many foot infections are treated improperly, including prescribing the wrong antibiotic or not addressing underlying conditions such as peripheral arterial disease.
The guideline’s primary focus is appropriate therapy for treating infected wounds on the feet of persons with diabetes, including surgical removal (debridement) of dead tissue, appropriate antibiotic therapy, removing pressure on the wound, and assessing (and potentially improving) blood flow to the foot. The guideline also provides suggestions regarding when and how long antibiotics should be administered for soft tissue and for bone infections.
Substandard treatment of infected foot wounds in people with diabetes can lead to lower extremity amputation, the guideline explains. Individuals with diabetes typically have poor circulation and little or no feeling in their feet; thus, a sore caused by a rubbing shoe or a cut can go unnoticed and worsen. “People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible,” said Benjamin A. Lipsky, MD, chair of the guideline review panel.
The guideline provides key recommendations on the preferred clinical methods to use when diagnosing a diabetic patient with foot infection. For example, clinicians should evaluate a diabetic patient presenting with a foot wound at three levels: the patient as a whole, the affected foot or limb, and the infected wound. The guideline also provides advice on when and how to culture a diabetic foot wound. Also, several recommendations are provided regarding when consultation for a patient with a diabetic foot infection is needed and from whom, and when to hospitalize (and to discharge) the patient.
As with other IDSA guidelines, the diabetic foot infections guideline will be available in a smartphone format and a pocket-sized quick-reference edition. A podcast with Dr. Lipsky, the lead guideline author, is available on IDSA’s website. The full guideline is available online. Visit the practice guidelines section of the IDSA website for additional guidelines and related resources.
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