The Infectious Diseases Society of America (IDSA) has issued revised and updated guidelines for the diagnosis and treatment of diabetes-related foot infections with the aim of preventing amputations. The guidelines were published in the June 15, 2012, issue of Clinical Infectious Diseases.
The new guidelines include ten common questions with evidence-based answers, which the panel that wrote the guidelines determined were most likely to help a healthcare provider treat a patient with a diabetes-related foot wound. The first step is to determine if the wound is infected. The guidelines emphasize the importance of rapid and appropriate therapy for treating infected wounds on the feet, typically including debridement of dead tissue; taking a culture of the wound to determine the bacteria causing the infection, which will then guide appropriate antibiotic therapy; and, if necessary, removing pressure on the wound and improving blood flow to the area. When a foot sore is infected, imaging the foot is usually necessary to determine if the bone is infected. Many patients with foot infections initially receive only antibiotic therapy, which is often insufficient in the absence of proper wound care and surgical interventions, the guidelines note.
“There is quite a bit of over-prescribing or inappropriate prescribing of antibiotics for diabetic foot wounds, which doesn’t help the patient and can lead to antibiotic resistance,” said Warren S. Joseph, DPM, FIDSA, co-author of the guidelines and a consultant for lower-limb infectious diseases.
The guidelines suggest that because treatment of diabetic foot infections can be complicated, the best approach is to involve a multidisciplinary team-which may include infectious disease and wound care specialists, endocrinologists, dermatologists, podiatrists, and general, vascular, orthopedic, and plastic surgeons-that can assess and address various aspects of the problem. Research since the previous 2004 guidelines shows that many foot infections are treated improperly, including prescribing the wrong antibiotic or not addressing underlying conditions such as peripheral arterial disease.
“Clearly, preventing amputations is vital, and in most cases, possible,” said Benjamin A. Lipsky, MD, FACP, FIDSA, chair of the guidelines review panel; lead author of the guidelines; professor of medicine at the University of Washington, Seattle; and director of the primary care clinic at the Veterans Affairs (VA) Puget Sound Healthcare System, Seattle.
The IDSA notes that the voluntary guidelines are not intended to replace a doctor’s judgment, but rather to support the decision-making process, which must be individualized according to each patient’s circumstances.
