Diabetic foot infections: Questions for an infectious disease consultant
Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious dise...
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| Published in | Seminars in vascular surgery Vol. 38; no. 1; pp. 85 - 93 |
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| Main Authors | , |
| Format | Journal Article |
| Language | English |
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United States
Elsevier Inc
01.03.2025
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| Abstract | Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines. |
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| AbstractList | Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines. ABSTRACTDiabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines. Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines.Diabetic foot infection can lead to limb amputation in approximately 17% of affected patients. Given the complex pathophysiology associated with diabetic foot infection, the goal of limb preservation is best achieved with a multidisciplinary approach and a team of providers including infectious disease consultants. However, these infections often affect populations living in nonmetropolitan areas, where access to an infectious disease physician may be limited. It may fall on the surgeons and primary care providers to not only diagnose infections early, including osteomyelitis, but also facilitate prompt, appropriate antibiotic management. The decision to treat with antibiotics alone versus surgery, choice of antibiotic, route of administration, and duration of treatment are complicated concepts that require a patient-specific approach. In addition, use of oral antibiotics and long-acting lipoglycopeptides has gained prominence and offers an alternate solution to the tedious, resource-intense process of outpatient intravenous antibiotic treatment. The goal of this article is to outline and address diagnostic and management questions that would be posed to an infectious disease consultant. The responses would include a literature review of current management concepts and highlights from the 2023 Infectious Disease Society of America and International Working Group on the Diabetic Foot guidelines. |
| Author | Nauriyal, Varidhi Byers, Karin |
| Author_xml | – sequence: 1 givenname: Varidhi surname: Nauriyal fullname: Nauriyal, Varidhi email: nauriyalv@upmc.edu organization: Divisions of Infectious Disease and Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Falk Medical Building, 7th Floor, Pittsburgh, PA 15213 – sequence: 2 givenname: Karin surname: Byers fullname: Byers, Karin organization: Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA |
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| Cites_doi | 10.1111/dme.13537 10.1053/j.jfas.2011.08.005 10.1002/dmrr.3250 10.1086/380449 10.1016/0002-9343(87)90894-1 10.1093/cid/ciw445 10.1111/j.1464-5491.2010.03150.x 10.1007/s00125-008-0940-0 10.1093/cid/cis346 10.1053/j.jfas.2006.04.002 10.3310/hta23610 10.4084/MJHID.2022.055 10.1093/clind/24.4.643 10.1093/ofid/ofy331 10.1080/07853890.2016.1231932 10.1056/NEJMoa1710926 10.1086/498112 10.2337/dc13-1526 10.1086/511036 10.1001/jama.2023.10578 10.1186/s13063-021-05472-6 10.2337/dc14-1514 10.1016/j.jcot.2020.12.014 10.1016/j.ejvs.2019.03.040 10.1002/dmrr.2425 10.1093/ofid/ofaa393 10.1007/s00125-006-0491-1 10.2337/dci22-0043 10.1093/cid/ciaa1758 10.1007/s10096-019-03547-6 10.1001/jamanetworkopen.2022.11321 10.1002/dmrr.3686 10.1001/jamanetworkopen.2019.16003 |
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| Keywords | Osteomyelitis Infectious Diabetes Antibiotics Guidelines |
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| SubjectTerms | Amputation, Surgical Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - adverse effects Antibiotics Clinical Decision-Making Consultants Diabetes Diabetic Foot - diagnosis Diabetic Foot - microbiology Diabetic Foot - therapy Guidelines Humans Infectious Limb Salvage Osteomyelitis Patient Care Team Referral and Consultation Risk Factors Surgery Treatment Outcome |
| Title | Diabetic foot infections: Questions for an infectious disease consultant |
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