Diabetic Foot Infections

EPIDEMIOLOGY
Increasing diabetes mellitus by 38% since 2004. Financial burden of foot ulcer is approximately $20,000 dollars within 2 years of diagnosis and lifetime cost of an amputation is approximately $50,000.

PATHOPHYSIOLOGY
– Direct bacterial invasion from skin ulcer break in the skin barrier
– Oxidative stress, poor nutrition, impaired neutrophil function, ischemia from vascular insufficiency
– Peripheral neuropathy leads to risk of developing foot ulcers. Sensory neuropathy leads to loss of protective sensation. Motor neuropathy leads to deformities that leading developing pressure points. Autonomic neuropathy causes skin dryness and cracking.
– Charcot’s neuroarthropathy – leads to macroscopic fracture and joint injury

IMPORTANT HISTORY
Previous foot ulcer or osteomyelitis

ASSESSMENT
– Lab work including A1c, WBC, CRP
– ABI for vascular insufficiency
– Plain radiograph for any patient presenting with diabetic foot infections, MRI for further diagnosis
– Wound culture, preferably deeper as superficial may not be consistent with the organism causing the infection

TREATMENT
Infections restricted to the soft tissues are treated for 1-4 weeks
Osteomyelitis is treated with complete debridement as well as antibiotic for 4-6 weeks

Wound care – dressings, surgical reconstruction, removing mechanical factors.
Maintaining a moist environment to expedite healing, basic gauze moistened with saline and allowed to dry. Moist to dry dressing. Avoid topical antibiotics.

Tight glycemic control and preventive measures

REFERENCES
1. Embil J. et al. Diabetic Foot Infections. Chapter 147. Principles & Practice of hospital medicine. Edition 2; 1131-1137 [2019].