Literature Review: Diabetic Foot Infection

Table of Contents

• General Guidelines
  
• Prevention
  
• Epidemiology
  
• Diagnostic Testing & Diagnosis
  
• Imaging & Diagnostics
  • Radiographs
  • Magnetic Resonance Imaging (MRI)
  • Nuclear Medicine
    
• Therapeutics & Management (Wound Care)
  
• Therapeutics & Management (Surgical)
  
• Osteomyelitis in the Diabetic Foot
  • Diagnosis
  • Treatment
    
• Transitions of Care & Discharge
  
  

General Guidelines

Specific guidelines for treatment of diabetic foot osteomyelitis.
PMID:18442187.

Complicated infections of skin and skin structures: when the infection is more than skin deep.
DiNubile MJ, Lipsky BA.  J Antimicrob Chemother. Jun 2004;53 Suppl 2:ii37-50. PMID:15150182.

Diabetic foot disorders. A clinical practice guideline (2006 revision).
Frykberg RG, Zgonis T, Armstrong DG, et al. J Foot Ankle Surg. Sep-Oct 2006;45(5 Suppl):S1-66. PMID:17280936.

Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK.
Gemmell CG, Edwards DI, Fraise AP, et al. J Antimicrob Chemother. Apr 2006;57(4):589-608. PMID:16507559.

Diagnosis and treatment of diabetic foot infections.
Clin Infect Dis. Lipsky BA, Berendt AR, Deery HG, et al.Oct 1 2004;39(7):885-910. PMID:15472838.

Practice guidelines for the diagnosis and management of skin and soft-tissue infections.
Stevens DL, Bisno AL, Chambers HF, et al. Clin Infect Dis. Nov 15 2005;41(10):1373-1406. PMID:16231249.

Prevention

Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention.
Cavanagh PR, Ulbrecht JS, Caputo GM. Diabetic Medicine. 1996;13 Suppl 1:S17-22. PMID: 8741823.

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention.
Mason J, O'Keeffe C, McIntosh A, et al. Diabetic Medicine. Oct 1999;16(10):801-812. PMID:10547206.

The behavior and psychological functioning of people at high risk of diabetes-related foot complications.
Perrin B, Swerissen H. Diabetes Educator. May-Jun 2008;34(3):493-500. PMID:18535322.

Patient education for preventing diabetic foot ulceration.
Valk GD, Kriegsman DM, Assendelft WJ.Cochrane Database of Systematic Reviews. 2005(1):CD001488. PMID:15674879.

Psychosocial and behavioral aspects of diabetic foot lesions.
Vileikyte L. Current Diabetes Reports. Apr 2008;8(2):119-125. PMID: 18445354.

Epidemiology

Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention.
Cavanagh PR, Ulbrecht JS, Caputo GM. Diabetic Medicine. 1996;13 Suppl 1:S17-22. PMID:8741823.

The pathobiology of diabetes mellitus: implications for surgeons. Journal of the American College of Surgeons.
Kamal K, Powell RJ, Sumpio BE. Sep 1996;183(3):271-289. PMID:8784324.

Risk factors for developing osteomyelitis in patients with diabetic foot wounds.
Lavery LA, Peters EJ, Armstrong DG, et al. Diabetes Research and Clinical Practice. Mar 2009;83(3):347-352. PMID:19117631.

The epidemiology of neuropathic foot ulcers in individuals with diabetes. Current Diabetes Reports.
Sosenko J. Dec 2002;2(6):477-481. PMID:12643153.

Diagnostic Testing & Diagnosis

Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study.
Jeandrot A, Richard JL, Combescure C, et al. Diabetologia. Feb 2008;51(2):347-352. PMID:17934713.

New developments in diagnosing and treating diabetic foot infections.
Lipsky BA.  Diabetes/Metabolism Research and Reviews. May-Jun 2008;24 Suppl 1:S66-71. PMID:18395871.

Systematic review of methods to diagnose infection in foot ulcers in diabetes.
O'Meara S, Nelson EA, Golder S, et al. Diabetic Medicine. Apr 2006;23(4):341-347. PMID:16620261.

Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection.
Pellizzer G, Strazzabosco M, Presi S, et al. Diabetic Medicine. Oct 2001;18(10):822-827. PMID:11678973.

Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Schaper NC. Diabetes/Metabolism Research and Reviews. May-Jun 2004;20 Suppl 1:S90-95. PMID:15150820.

Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system.
Lavery LA, Armstrong DG, Murdoch DP, et al.  Clin Infect Dis. Feb 15, 2007;46:562-5. PMID: 17243061.

Imaging & Diagnostics

Radiographs

Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis.
Dinh MT, Abad CL, Safdar N. Clinical Infectious Diseases. Aug 15 2008;47(4):519-527. PMID:18611152.

Does this patient with diabetes have osteomyelitis of the lower extremity?
Butalia S, Palda VA, Sargeant RJ, et al. JAMA. Feb 20 2008;299(7):806-813. PMID:18285592.

Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers.
Shults DW, Hunter GC, McIntyre KE, et al.  Am J Surg. Dec 1989;158(6):525-529; discussion 529-530. PMID: 2589582.

Magnetic Resonance Imaging (MRI)

Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation.
Craig JG, Amin MB, Wu K, et al. Radiology. Jun 1997;203(3):849-855. PMID: 9169715.

The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning.
Ertugrul MB, Baktiroglu S, Salman S, et al.Diabetic Medicine. Jun 2006;23(6):649-653. PMID: 16759307.

Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis.
Rozzanigo U, Tagliani A, Vittorini E, et al. La Radiologia Medica. Feb 2009;114(1):121-132. PMID: 18956147.

MR imaging of the diabetic foot.
Russell JM, Peterson JJ, Bancroft LW. Magnetic Resonance Imaging Clinics of North America. Feb 2008;16(1):59-70, vi. PMID: 18440478.

Unsuspected osteomyelitis is frequent in persistent diabetic foot ulcer and better diagnosed by MRI than by 18F-FDG PET or 99mTc-MOAB.
Schwegler B, Stumpe KD, Weishaupt D, et al. Journal of Internal Medicine. Jan 2008;263(1):99-106. PMID: 18036160.

MR imaging of the diabetic foot.
Schweitzer ME, Morrison WB. Radiol Clin North Am. Jan 2004;42(1):61-71, vi. PMID: 15049523.

Pedal abscesses in patients suspected of having pedal osteomyelitis: analysis with MR imaging.
Ledermann HP, Morrison WB, Schweitzer ME. Radiology 2002;224:649-55. PMID: 12202694.

Nuclear Medicine

Positron emission tomography as a diagnostic tool in infection: present role and future possibilities.
Basu S, Chryssikos T, Moghadam-Kia S, et al.  Seminars in Nuclear Medicine. Jan 2009;39(1):36-51. PMID: 19038599.

Nuclear medicine imaging of diabetic foot infection: results of meta-analysis.
Capriotti G, Chianelli M, Signore A. Nuclear Medicine Communications. Oct 2006;27(10):757-764. PMID: 16969256.

Prospective study of bone, indium-111-labeled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot.
Johnson JE, Kennedy EJ, Shereff MJ, et al. Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. Jan 1996;17(1):10-16. PMID: 8821280.

Nuclear medicine and diabetic foot infections.
Palestro CJ, Love C. Seminars in Nuclear Medicine. Jan 2009;39(1):52-65. PMID: 19038600.

Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers.
Shults DW, Hunter GC, McIntyre KE, et al.  Am J Surg. Dec 1989;158(6):525-529; discussion 529-530. PMID: 2589582.

Therapeutics & Management (Wound Care)

Wound healing agents.
Adams SB, Jr., Sabesan VJ, Easley ME.  Foot and Ankle Clinics. Dec 2006;11(4):745-751. PMID: 17097514.

Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial.
Blume PA, Walters J, Payne W, et al. Diabetes Care. Apr 2008;31(4):631-636. PMID: 18162494.

Nonsurgical strategies for healing and preventing recurrence of diabetic foot ulcers.
Cavanagh PR, Owings TM. Foot and Ankle Clinics. Dec 2006;11(4):735-743. PMID: 17097513.

Biomechanical aspects of diabetic foot disease: aetiology, treatment, and prevention.
Cavanagh PR, Ulbrecht JS, Caputo GM. Diabetic Medicine. 1996;13 Suppl 1:S17-22. PMID: 8741823.

Hyperbaric oxygen, oxidative stress, NO bioavailability and ulcer oxygenation in diabetic patients.
Efrati S, Gall N, Bergan J, et al. Undersea & Hyperbaric Medicine. Jan-Feb 2009;36(1):1-12. PMID: 19341122.

Diabetic foot ulcers: pathogenesis and management.
Frykberg RG.  American Family Physician. Nov 1 2002;66(9):1655-1662. PMID: 12449264.

New developments in diagnosing and treating diabetic foot infections.
Lipsky BA. Diabetes/Metabolism Research and Reviews. May-Jun 2008;24 Suppl 1:S66-71. PMID: 18395871.

Clinical predictors of treatment failure for diabetic foot infections: data from a prospective trial.
Lipsky BA, Sheehan P, Armstrong DG, et al.  International Wound Journal. Mar 2007;4(1):30-38. PMID: 17425547.

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus.
Mason J, O'Keeffe C, Hutchinson A, et al.  II: treatment. Diabetic Medicine. Nov 1999;16(11):889-909. PMID: 10588519.

Impact of antimicrobial gauze on bacterial colonies in wounds that require packing.
Motta GJ, Milne CT, Corbett LQ. Ostomy/Wound Management. Aug 2004;50(8):48-62. PMID: 15356368.

Systematic review of antimicrobial agents used for chronic wounds.
O'Meara SM, Cullum NA, Majid M, et al. The British Journal of Surgery. Jan 2001;88(1):4-21. PMID: 11136304.

Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises?
Papanas N, Maltezos E.  The International Journal of Lower Extremity Wounds. Mar 2007;6(1):37-53. PMID: 17344201.

Therapeutics and Management (Antibiotics) Systematic review of antimicrobial treatments for diabetic foot ulcers.
Nelson EA, O'Meara S, Golder S, et al. Diabetic Medicine. Apr 2006;23(4):348-359. PMID: 16620262.

Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections.
Lipsky BA, Stoutenburgh U.  The Journal of Antimicrobial Chemotherapy. Feb 2005;55(2):240-245. PMID: 15659542.

Novel antibiotics for the management of diabetic foot infections.
Omar NS, El-Nahas MR, Gray J. International Journal of Antimicrobial Agents. May 2008;31(5):411-419. PMID: 18155884.

Medical treatment of diabetic foot infections.
Lipsky BA. Clin Infect Dis 2004;39:S104-14 PMID: 15306988.

Treating foot infections in diabetic patients: a randomized, multicenter, open-label trial of linezolid versus ampicillin-sulbactam/amoxicillin-clavulanate.
Lipsky BA, Itani K, Norden C, and the Linezolid Diabetic Foot Infections Study Group. Clin Infect Dis. Jan 1 2004;38:17-24. PMID: 1467944.

Factors associated with treatment failure in patients with diabetic foot infections: an analysis of data from randomized controlled trials.
Vardakas KZ, Horianopoulou M, Falagas ME. Diab Res Clin Pract 2008;80:344-51. PMID: 18291550 .

Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial.
Lipsky BA, Armstrong DG, Citron DM, et al.  Lancet. Nov 12, 2005;366:1695-1703. PMID: 16291062.

Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate.
Lipsky BA, Giordano P, Choudri S, et al.  J Antimicrob Chemother. Aug 2007;60:370-6. PMID: 17553812.

Therapeutics & Management (Surgical)

Skin replacement therapies for diabetic foot ulcers: systematic review and meta-analysis.
Blozik E, Scherer M. Diabetes Care. Apr 2008;31(4):693-694. PMID: 18162495.

Protocol for treatment of diabetic foot ulcers.
Brem H, Sheehan P, Boulton AJ. American Journal of Surgery. May 2004;187(5A):1S-10S. PMID: 15147985.

Diabetic foot disorders. A clinical practice guideline (2006 revision).
Frykberg RG, Zgonis T, Armstrong DG, et al. J Foot Ankle Surg. Sep-Oct 2006;45(5 Suppl):S1-66. PMID: 17280936.

The treatment of diabetic foot ulcers: reviewing the literature and a surgical algorithm.
Kravitz SR, McGuire JB, Sharma S. Advances in Skin & Wound Care. Apr 2007;20(4):227-237; quiz 237-229. PMID: 17415031.

The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial.
Marston WA, Hanft J, Norwood P, et al. Diabetes Care. Jun 2003;26(6):1701-1705. PMID: 12766097.

Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial.
Piaggesi A, Schipani E, Campi F, et al. Diabetic Medicine. May 1998;15(5):412-417. PMID: 9609364.

Surgical treatment of problem foot wounds in patients with diabetes.
Strauss MB. Clinical Orthopaedics and Related Research. Oct 2005;439:91-96. PMID: 16205145.

Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation?
Tan JS, Friedman NM, Hazelton-Miller C, et al. Clin Infect Dis. Aug 1996;23(2):286-291. PMID: 8842265.

The high-low amputation ratio: a deeper insight into diabetic foot care?
Wrobel JS, Robbins J, Armstrong DG. J Foot Ankle Surg. Nov-Dec 2006;45(6):375-379. PMID: 17145462.

Advanced plastic surgery techniques for soft tissue coverage of the diabetic foot.
Zgonis T, Stapleton JJ, Roukis TS. Clinics in Podiatric Medicine and Surgery. Jul 2007;24(3):547-568, x. PMID: 17613391.

Osteomyelitis in the Diabetic Foot

Diagnosis

Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis.
Dinh MT, Abad CL, Safdar N. Clinical Infectious Diseases. Aug 15 2008;47(4):519-527. PMID: 18611152.

Does this patient with diabetes have osteomyelitis of the lower extremity?
Butalia S, Palda VA, Sargeant RJ, et al. JAMA. Feb 20 2008;299(7):806-813. PMID: 18285592.

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment.
Berendt AR, Peters EJ, Bakker K, et al. Diabetes/Metabolism Research and Reviews. May-Jun 2008;24 Suppl 1:S145-161. PMID: 18442163.

Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot.
Fleischer AE, Didyk AA, Woods JB, et al. The Journal of Foot and Ankle Surgery. Jan-Feb 2009;48(1):39-46. PMID: 19110158.

Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis.
Kapoor A, Page S, Lavalley M, et al. Arch Intern Med. Jan 22 2007;167(2):125-132. PMID: 17242312.

Comparison of microbiological results of needle puncture vs. superficial swab in infected diabetic foot ulcer with osteomyelitis.
Kessler L, Piemont Y, Ortega F, et al. Diabetic Medicine. Jan 2006;23(1):99-102. PMID: 16409574.

Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients.
Grayson ML, Gibbons GW, Balogh K, et al. JAMA. Mar 1 1995;273(9):721-723. PMID: 7853630.

Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic?
Lavery LA, Armstrong DG, Peters EJ, et al. Diabetes Care. Feb 2007;30(2):270-274. PMID: 17259493.

Probing the validity of the probe-to-bone test in the diagnosis of osteomyelitis of the foot in diabetes.
Shone A, Burnside J, Chipchase S, Game F, Jeffcoate W. Diabetes Care 2006;29:945. PMID: 16567847.

Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot.
Senneville E, Morant H, Descamps D, et al. Clinical Infectious Diseases. Apr 1 2009;48(7):888-893. PMID: 19228109.

ACR Appropriateness Criteria on suspected osteomyelitis in patients with diabetes mellitus.
Schweitzer ME, Daffner RH, Weissman BN, et al. J Am Coll Radiol. Aug 2008;5(8):881-886. PMID: 18657783.

Controversies in diagnosing and managing osteomyelitis of the foot in diabetes.
Jeffcoate WJ, Lipsky BA.Clin Infect Dis 2004;39:S115-22. PMID: 15306989.

Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot.
Fleischer AE, Didyk AA, Woods JB, Burns SE, Wrobel JS, Armstrong DG. J Foot Ankle Surg. 2009 ; 48:39-46. PMID: 19110158.

"Sausage toe" : a reliable sign of underlying osteomyelitis.
Rajbhandari SM, Sutton M, Davies C, Tesfaye S, Ward JD.  Diabet Med 2000; 17:74-7. PMID: 10691164.

Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot.
Berendt AR, Lipsky BA. Curr Diab Rep 2004;4:424-9. PMID: 15539006.

Treatment

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment.
Berendt AR, Peters EJ, Bakker K, et al.  Diabetes/Metabolism Research and Reviews. May-Jun 2008;24 Suppl 1:S145-161. PMID: 18442163.

Specific guidelines for treatment of diabetic foot osteomyelitis.
Berendt AR, Peters EJ, Bakker K, et al. Diabetes/Metabolism Research and Reviews. May-Jun 2008;24 Suppl 1:S190-191. PMID: 18442187.

Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study.
Senneville E, Lombart A, Beltrand E, et al.  Diabetes Care. Apr 2008;31(4):637-642. PMID: 18184898.

Primarily non-surgical management of osteomyelitis of the foot in diabetes.
Diabetologia. Jun 2008;51(6):962-967. Game FL, Jeffcoate WJ. PMID: 18385975.

Oral antimicrobial therapy for diabetic foot osteomyelitis.
Embil JM, Rose G, Trepman E et al. Foot Ankle Int 2006; 27:771-9. PMID: 17054876.

Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement.
Aragon-Sanchez FJ, Cabrera-Galvan JJ, Quintana-Marrero Y, et al. Diabetologia. Nov 2008;51(11):1962-1970. PMID: 18719880.

Surgical management of diabetic foot infections and osteomyelitis.
Frykberg RG, Wittmayer B, Zgonis T. Clin Podiatr Med Surg. July 2007;24:469-82, viii-ix. PMID: 17613386.

Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American society of health systems pharmacists, the infectious diseases society of America and the society of infectious disease pharmacists.
Rybak M, Lomaestro B, Rotschafer JC, et al. AJHP 2009;66:82-98. PMID: 19106348.

Practice guidelines for outpatient parenteral antimicrobial therapy.
Tice AD, Rehm SJ, Dalovisio JR, et al. CID 2004;38:1651-72. PMID:15227610.

Transitions of Care & Discharge

Hospital discharges for diabetic foot disease in New Zealand: 1980-1993.
Payne CB, Scott RS. Diabetes Research and Clinical Practice. Jan 1998;39(1):69-74. PMID: 9597376.

Diabetes-related lower extremity amputations in the community: a study based on hospital discharge diagnoses.
Vaccaro O, Lodato S, Mariniello P, et al. Nutrition, Metabolism, and Cardiovascular Diseases. Dec 2002;12(6):331-336. PMID: 12669680.

The national hospital discharge register data on lower limb amputations.
Winell K, Niemi M, Lepantalo M. European Journal of Vascular and Endovascular Surgery. Jul 2006;32(1):66-70. PMID: 16513375.

Clinical outcome of diabetic foot ulcers treated with negative pressure wound therapy and the transition from acute care to home care.
Wu SC, Armstrong DG. International Wound Journal. Jun 2008;5 Suppl 2:10-16. PMID: 18577133.