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Principles and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct; 16 Suppl 1:S42-6.DM

Abstract

Foot infections are a common and serious problem in diabetic patients. They usually occur as a consequence of a skin ulceration, which initially is colonized with normal flora, and later infected with pathogens. Infection is defined clinically by evidence of inflammation, and appropriate cultures can determine the microbial etiology. Aerobic gram-positive cocci are the most important pathogens; in chronic, complex or previously treated wounds, gram-negative bacilli and anaerobes may join in a polymicrobial infection. In all diabetic foot infections a primary consideration is whether or not surgical intervention is required, e.g. for undrained pus, wound debridement or revascularization. Antibiotic regimens are usually selected empirically initially, then modified if needed based on results of culture and sensitivity tests and the patient's clinical response. Initial therapy, especially in serious infections, may need to be broad-spectrum, but definitive therapy can often be more targeted. Severe infections usually require intravenous therapy initially, but milder cases can be treated with oral agents. Treatment duration ranges from 1-2 weeks (for mild soft tissue infection) to more than 6 weeks (for osteomyelitis). The choice of a specific agent should be based on the usual microbiology of these infections, data from published clinical trials, the severity of the patient's infection, and the culture results. Extension of infection into underlying bone can be difficult to diagnose and may require imaging tests, e.g. magnetic resonance scans. Cure of osteomyelitis usually requires resection of infected bone, but can be accomplished with prolonged antibiotic therapy. Various non-antimicrobial adjunct therapies may sometimes be helpful. Published in 2000 by John Wiley & Sons, Ltd.

Authors+Show Affiliations

University of Washington, School of Medicine, Seattle, USA. balipsky@u.washington.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

11054887

Citation

Lipsky, B A., and A R. Berendt. "Principles and Practice of Antibiotic Therapy of Diabetic Foot Infections." Diabetes/metabolism Research and Reviews, vol. 16 Suppl 1, 2000, pp. S42-6.
Lipsky BA, Berendt AR. Principles and practice of antibiotic therapy of diabetic foot infections. Diabetes Metab Res Rev. 2000;16 Suppl 1:S42-6.
Lipsky, B. A., & Berendt, A. R. (2000). Principles and practice of antibiotic therapy of diabetic foot infections. Diabetes/metabolism Research and Reviews, 16 Suppl 1, S42-6.
Lipsky BA, Berendt AR. Principles and Practice of Antibiotic Therapy of Diabetic Foot Infections. Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6. PubMed PMID: 11054887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Principles and practice of antibiotic therapy of diabetic foot infections. AU - Lipsky,B A, AU - Berendt,A R, PY - 2000/10/31/pubmed PY - 2001/2/28/medline PY - 2000/10/31/entrez SP - S42 EP - 6 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab Res Rev VL - 16 Suppl 1 N2 - Foot infections are a common and serious problem in diabetic patients. They usually occur as a consequence of a skin ulceration, which initially is colonized with normal flora, and later infected with pathogens. Infection is defined clinically by evidence of inflammation, and appropriate cultures can determine the microbial etiology. Aerobic gram-positive cocci are the most important pathogens; in chronic, complex or previously treated wounds, gram-negative bacilli and anaerobes may join in a polymicrobial infection. In all diabetic foot infections a primary consideration is whether or not surgical intervention is required, e.g. for undrained pus, wound debridement or revascularization. Antibiotic regimens are usually selected empirically initially, then modified if needed based on results of culture and sensitivity tests and the patient's clinical response. Initial therapy, especially in serious infections, may need to be broad-spectrum, but definitive therapy can often be more targeted. Severe infections usually require intravenous therapy initially, but milder cases can be treated with oral agents. Treatment duration ranges from 1-2 weeks (for mild soft tissue infection) to more than 6 weeks (for osteomyelitis). The choice of a specific agent should be based on the usual microbiology of these infections, data from published clinical trials, the severity of the patient's infection, and the culture results. Extension of infection into underlying bone can be difficult to diagnose and may require imaging tests, e.g. magnetic resonance scans. Cure of osteomyelitis usually requires resection of infected bone, but can be accomplished with prolonged antibiotic therapy. Various non-antimicrobial adjunct therapies may sometimes be helpful. Published in 2000 by John Wiley & Sons, Ltd. SN - 1520-7552 UR - https://www.unboundmedicine.com/medline/citation/11054887/Principles_and_practice_of_antibiotic_therapy_of_diabetic_foot_infections_ DB - PRIME DP - Unbound Medicine ER -
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