Foot infections are the most common problems in persons with diabetes. These individuals are predisposed to foot infections because of a compromised vascular supply secondary to diabetes. Local trauma and/or pressure, in addition to micro vascular disease, may result in various diabetic foot infections that run the spectrum from simple, superficial cellulites to chronic osteomyelitis. The mortality rate for diabetics due to poor treatments of infected foot wounds that can subsequently lead to lower extremity amputation is worse than for the majority of cancers, given that around 50% of diabetics with foot amputations die within five years. Except for chronic osteomyelitis, infections in patients with diabetes are caused by the same microorganisms that can infect the extremities of persons without diabetes. Gas gangrene is conspicuous because of its low incidence in patients with diabetes, but deep-skin and soft-tissue infections, which are due to gas-producing organisms, frequently occur in patients with these infections. In general, foot infections in persons with diabetes become more severe and take longer to cure than do equivalent infections in persons without diabetes.
Infections in patients with diabetes are difficult to treat because these individuals have impaired micro vascular circulation, which limits the access of phagocytes to the infected area and results in a poor concentration of antibiotics in the infected tissues. In addition, diabetic individuals can not only have a combined infection involving bone and soft tissue called fetid foot, a severe and extensive, chronic soft-tissue and bone infection that causes a foul exudate, but they may also have peripheral vascular disease that involves the large vessels, as well as micro vascular and capillary disease that results in peripheral vascular disease with gangrene.
Thus, treating diabetic foot infections can pose a real challenge. However certain guidelines can be really helpful in treating a diabetic patient’s foot infection. The first thing is establishing whether the wound is infected. A sign of infection includes at least two of the following symptoms: redness, tenderness, warmth, pain or swelling. Further, diabetics with infected foot ulcers should generally have their foot imaged to determine whether the infection has spread to the bone. Another important treatment aspect is to grow a culture of the bacteria that has caused the infection, as this will assist in choosing the best antibiotics. Multidisciplinary team should be employed due to the complexity of diabetic foot infections, which includes infectious diseases specialists, surgeons, podiatrists and orthopedists. Also, 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. When antibiotics are necessary they should be discontinued when the infection is gone, even if the wound hasn’t completely healed.