J Korean Diabetes.  2011 Jun;12(2):83-87. 10.4093/jkd.2011.12.2.83.

Antimicrobial Therapy in Diabetic Foot Infections

• Song JY

• KMID: 2137327
• DOI: http://doi.org/10.4093/jkd.2011.12.2.83

Abstract

Treatment of diabetic foot infection remains a challenging issue to be solved. Bacterial species complicating diabetic foot ulcer differ from those of non-diabetic patients. Empirical antibiotic regimens are selected based on the severity and type of infection (acute infection versus chronic infection), which should always include coverage for aerobic Gram-positive cocci, especially Staphylococcus aureus. Narrow-spectrum antibiotic agents are considered for mild-to-moderate, recent infections, while broad-spectrum agents are usually required for severe, chronic infections, targeting both Gram-positive cocci and Gram-negative bacilli.

Keyword

Diabetes; Foot infection; Antimicrobial agent; Empirical therapy

MeSH Terms

Diabetic Foot
Gram-Positive Cocci
Humans
Staphylococcus aureus
Ulcer

Reference

1. Boulton AJ. The diabetic foot: a global view. Diabetes Metab Res Rev. 2000; 16(Suppl 1):S2–5.

2. Senneville E. Antimicrobial interventions for the management of diabetic foot infections. Expert Opin Pharmacother. 2005; 6:263–73.

3. Byren I, Peters EJ, Hoey C, Berendt A, Lipsky BA. Pharmacotherapy of diabetic foot osteomyelitis. Expert Opin Pharmacother. 2009; 10:3033–47.

4. Grayson ML. Diabetic foot infections. Antimicrobial therapy. Infect Dis Clin North Am. 1995; 9:143–61.

5. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS. Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004; 39:885–910.

6. Rao N, Lipsky BA. Optimising antimicrobial therapy in diabetic foot infections. Drugs. 2007; 67:195–214.

7. Choi SR, Lee CK, Kim DW, Han SK, Kim WK. Bacteriology and antibiotic sensitivity for diabetic foot ulcer. J Korean Soc Plast Reconstr Surg. 2006; 33:330–4.

8. Park SJ, Jung HJ, Shin HK, Kim E, Lim JJ, Yoon JW. Microbiology and antibiotic selection for diabetic foot infections. J Korean Foot Ankle Soc. 2009; 13:150–5.

9. Seo YB, Noh JY, Huh JY, Lee J, Song JY, Han SK, Kim WJ, Cheong HJ. Diabetic foot infection: microbiologic analysis based on deep tissue biopsy. Infect Chemother. 2007; 39:237–42.

10. Lipsky BA. Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection? Clin Microbiol Infect. 2007; 13:351–3.

11. Dang CN, Prasad YD, Boulton AJ, Jude EB. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med. 2003; 20:159–61.

12. Tentolouris N, Jude EB, Smirnof I, Knowles EA, Boulton AJ. Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic. Diabet Med. 1999; 16:767–71.

13. Tentolouris N, Petrikkos G, Vallianou N, Zachos C, Daikos GL, Tsapogas P, Markou G, Katsilambros N. Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect. 2006; 12:186–9.

14. Lipsky BA. International consensus group on diagnosing and treating the infected diabetic foot. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabetes Metab Res Rev. 2004; 20(Suppl 1):S68–77.

15. Chantelau E, Tanudjaja T, Altenhöfer F, Ersanli Z, Lacigova S, Metzger C. Antibiotic treatment for uncomplicated neuropathic forefoot ulcers in diabetes: a controlled trial. Diabet Med. 1996; 13:156–9.

16. Hirschl M, Hirschl AM. Bacterial flora in mal perforant and antimicrobial treatment with ceftriaxone. Chemotherapy. 1992; 38:275–80.

17. Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med. 2005; 16:567–70.

18. Fierer J, Daniel D, Davis C. The fetid foot: lower-extremity infections in patients with diabetes mellitus. Rev Infect Dis. 1979; 1:210–7.