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A Current Approach to Diabetic Foot Infections.
Curr Infect Dis Rep. 1999 Aug; 1(3):253-260.CI

Abstract

Foot infections are a common, complex, and serious problem in diabetic patients. Infections usually begin in foot ulcers, which are associated with neuropathy, vasculopathy, and various metabolic disturbances. These infections are potentially limb and sometimes life threatening. Etiologic agents are usually aerobic gram-positive cocci, but chronic or serious infections often contain gram-negative rods and anaerobes. Chronic infections can lead to contiguous bone infection. Diagnosing osteomyelitis may require imaging studies (especially magnetic resonance imaging) and occasionally bone biopsy. In addition to proper cleansing, debridement, and local wound care, diabetic foot infections require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy, but appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) agents. Initial antibiotic selection is usually empiric; modifications may be needed based on the results of properly obtained cultures and the clinical response. Therapy should be active against staphylococci and streptococci, with broader-spectrum agents indicated if polymicrobial infection is likely. Levels of most antibiotics, except fluoroquinolones, are often subtherapeutic in infected foot tissues. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). No single antibiotic agent or combination has proven to be optimal. With appropriate local, surgical, and antimicrobial therapy, most diabetic foot infections can now be successfully treated.

Authors+Show Affiliations

Department of Medicine, University of Washington School of Medicine, Antibiotic Research Clinic (S-111 GIMC), VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108-1597, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11095796

Citation

Lipsky, BA. "A Current Approach to Diabetic Foot Infections." Current Infectious Disease Reports, vol. 1, no. 3, 1999, pp. 253-260.
Lipsky BA. A Current Approach to Diabetic Foot Infections. Curr Infect Dis Rep. 1999;1(3):253-260.
Lipsky, B. A. (1999). A Current Approach to Diabetic Foot Infections. Current Infectious Disease Reports, 1(3), 253-260.
Lipsky BA. A Current Approach to Diabetic Foot Infections. Curr Infect Dis Rep. 1999;1(3):253-260. PubMed PMID: 11095796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Current Approach to Diabetic Foot Infections. A1 - Lipsky,BA, PY - 2000/11/30/pubmed PY - 2000/11/30/medline PY - 2000/11/30/entrez SP - 253 EP - 260 JF - Current infectious disease reports JO - Curr Infect Dis Rep VL - 1 IS - 3 N2 - Foot infections are a common, complex, and serious problem in diabetic patients. Infections usually begin in foot ulcers, which are associated with neuropathy, vasculopathy, and various metabolic disturbances. These infections are potentially limb and sometimes life threatening. Etiologic agents are usually aerobic gram-positive cocci, but chronic or serious infections often contain gram-negative rods and anaerobes. Chronic infections can lead to contiguous bone infection. Diagnosing osteomyelitis may require imaging studies (especially magnetic resonance imaging) and occasionally bone biopsy. In addition to proper cleansing, debridement, and local wound care, diabetic foot infections require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy, but appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) agents. Initial antibiotic selection is usually empiric; modifications may be needed based on the results of properly obtained cultures and the clinical response. Therapy should be active against staphylococci and streptococci, with broader-spectrum agents indicated if polymicrobial infection is likely. Levels of most antibiotics, except fluoroquinolones, are often subtherapeutic in infected foot tissues. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). No single antibiotic agent or combination has proven to be optimal. With appropriate local, surgical, and antimicrobial therapy, most diabetic foot infections can now be successfully treated. SN - 1523-3847 UR - https://www.unboundmedicine.com/medline/citation/11095796/A_Current_Approach_to_Diabetic_Foot_Infections_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=11095796.ui DB - PRIME DP - Unbound Medicine ER -
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