New guidelines released by the Infectious Diseases Society of America (IDSA) and publishing in the June issue of Clinical Infectious Diseases emphasize that proper treatment of diabetic foot infections not only saves limbs – but can save lives. Diabetic foot infections are becoming more common, and about 50% of patients who have a foot amputation die within 5 years.
According to the new IDSA guidelines, about half of lower extremity amputations that aren’t caused by trauma can be prevented through proper care of foot infections. The new guidelines include 10 common questions with extensive, evidence-based answers, which the panel that wrote the guidelines determined were most likely to help a healthcare provider treating a patient with diabetes who has a foot wound.
Key points from the guidelines include:
Evidence of infection generally includes at least two of the following signs: redness, warmth, tenderness, pain, or swelling. The guidelines note that half of ulcers are not infected and don’t require antibiotics.
Rapid and appropriate therapy for treating infected wounds on the feet, typically including debridement, antibiotic therapy, and/or removing pressure on the wound and improving blood flow to the area.
When a foot sore infection is detected, imaging the foot is usually necessary to determine if the bone is infected.
A culture of infected wounds should be performed to determine the bacteria causing the infection and to help guide antibiotic treatment.
Antibiotic therapy is often insufficient in the absence of proper wound care and surgical interventions.
Use of a multidisciplinary team to assess and address various aspects of the problem is recommended.
Over-prescribing and inappropriate prescribing of antibiotics is common for diabetic foot wounds, which may lead to antibiotic resistance.
All patients with a severe infection, selected patients with a moderate infection with complicating features (eg, severe peripheral arterial disease or lack of home support), and any patient unable to comply with the required outpatient treatment regimen for psychological or social reasons be hospitalized initially.
Patients who are failing to improve with outpatient therapy may also need to be hospitalized.
Clinicians should consider osteomyelitis as a potential complication of any infected, deep, or large foot ulcer, especially one that is chronic or overlies a bony prominence.
Click here for the full IDSA guidelines.
Click here to view the IDSA press release.