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Optimising antimicrobial therapy in diabetic foot infections.
Drugs. 2007; 67(2):195-214.D

Abstract

Foot infections are common and the most serious lower extremity complication contributing to amputations, particularly in patients with diabetes mellitus. Infection is most often a consequence of foot ulcerations, which typically follows trauma to a neuropathic foot. Foot infections may be classified as mild, moderate and severe; this largely determines the approach to therapy. Gram-positive bacteria are the sole causative pathogens for most mild and moderate infections. These infections can usually be treated with culture-based narrow-spectrum antibacterials along with appropriate surgical debridement in an outpatient setting. In contrast, severe infections are often polymicrobial, requiring hospitalisation and treatment with broad-spectrum antibacterials along with appropriate medical and surgical interventions. The initial empirical antibacterial regimen may be tailored based on the results of culture and sensitivity tests from properly obtained specimens. Several antibacterial regimens have demonstrated effectiveness in randomised controlled trials, but no single regimen has shown superiority. Managing diabetic foot osteomyelitis is particularly controversial and requires reliable cultures to select an appropriate antibacterial regimen. Surgical resection of the infected and necrotic bone favours a good outcome in chronic osteomyelitis. The recommended duration of antibacterial therapy ranges from 1 to 4 weeks for soft tissue infection, to >6 weeks for unresected osteomyelitis. The incidence of meticillin-resistant Staphylococcus aureus infection is increasing in both the healthcare setting and the community. This should be considered when selecting an antibacterial, especially if the patient does not improve with initial antibacterial therapy. Certain other organisms, such as Pseudomonas aeruginosa and Enterococcus spp., while potentially pathogenic, are often colonisers that do not require targeted therapy.

Authors+Show Affiliations

Division of Infectious Disease, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232-1381, USA. raon@upmc.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17284084

Citation

Rao, Nalini, and Benjamin A. Lipsky. "Optimising Antimicrobial Therapy in Diabetic Foot Infections." Drugs, vol. 67, no. 2, 2007, pp. 195-214.
Rao N, Lipsky BA. Optimising antimicrobial therapy in diabetic foot infections. Drugs. 2007;67(2):195-214.
Rao, N., & Lipsky, B. A. (2007). Optimising antimicrobial therapy in diabetic foot infections. Drugs, 67(2), 195-214.
Rao N, Lipsky BA. Optimising Antimicrobial Therapy in Diabetic Foot Infections. Drugs. 2007;67(2):195-214. PubMed PMID: 17284084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimising antimicrobial therapy in diabetic foot infections. AU - Rao,Nalini, AU - Lipsky,Benjamin A, PY - 2007/2/8/pubmed PY - 2007/5/2/medline PY - 2007/2/8/entrez SP - 195 EP - 214 JF - Drugs JO - Drugs VL - 67 IS - 2 N2 - Foot infections are common and the most serious lower extremity complication contributing to amputations, particularly in patients with diabetes mellitus. Infection is most often a consequence of foot ulcerations, which typically follows trauma to a neuropathic foot. Foot infections may be classified as mild, moderate and severe; this largely determines the approach to therapy. Gram-positive bacteria are the sole causative pathogens for most mild and moderate infections. These infections can usually be treated with culture-based narrow-spectrum antibacterials along with appropriate surgical debridement in an outpatient setting. In contrast, severe infections are often polymicrobial, requiring hospitalisation and treatment with broad-spectrum antibacterials along with appropriate medical and surgical interventions. The initial empirical antibacterial regimen may be tailored based on the results of culture and sensitivity tests from properly obtained specimens. Several antibacterial regimens have demonstrated effectiveness in randomised controlled trials, but no single regimen has shown superiority. Managing diabetic foot osteomyelitis is particularly controversial and requires reliable cultures to select an appropriate antibacterial regimen. Surgical resection of the infected and necrotic bone favours a good outcome in chronic osteomyelitis. The recommended duration of antibacterial therapy ranges from 1 to 4 weeks for soft tissue infection, to >6 weeks for unresected osteomyelitis. The incidence of meticillin-resistant Staphylococcus aureus infection is increasing in both the healthcare setting and the community. This should be considered when selecting an antibacterial, especially if the patient does not improve with initial antibacterial therapy. Certain other organisms, such as Pseudomonas aeruginosa and Enterococcus spp., while potentially pathogenic, are often colonisers that do not require targeted therapy. SN - 0012-6667 UR - https://www.unboundmedicine.com/medline/citation/17284084/Optimising_antimicrobial_therapy_in_diabetic_foot_infections_ DB - PRIME DP - Unbound Medicine ER -