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2012, Number 3

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Cir Gen 2012; 34 (3)

Diagnosis, classification, and treatment of infections in the diabetic foot

Martínez DFR, Guerrero TG, Ochoa HP, Anaya PR, Muñoz PJA, Jiménez GR, Márquez SG, Jubiz PY, Clerici G, Landa SM, Gutiérrez AP, Martínez MFN

Language: Spanish
References: 29
Page: 199-205
PDF size: 155.81 Kb.


ABSTRACT

Objective: To review the literature to establish guidelines and recommendations to diminish amputation and deaths related to diabetic foot infections.
Setting: Centro de Prevención y Salvamento de Pie Diabético San Elian, Veracruz, Veracruz, Mexico.
Design: Review of the literature.
Material and Methods: We performed a search in the literature to find an adequate answer to the following research questions: classification of the infection (how to determine the severity of the infection), relevance of classifying (how is a severe infection defined, what score can be given to osteomyelitis in the severity of the infection) and treatment (optimal time, non-surgical treatment, antibiotics use, handling of osteomyelitis, and time of treatment).
Results: PEDIS (perfusion, extension, depth, infection, and sensitivity), IDSA (Infectious Disease Society of America) and San Elian classify the infection as mild, moderate and severe. Surgical debridement of the infected tissue must be performed without delay initially and subsequently as many times as required with “unroofing” of fistulous tracts. In moderate to severe infections an ample coverage (Gram positive and Gram negative and anaerobic bacteria) treatment is recommended. Culturing of the injury before or during empirical treatment is performed for moderate to severe infections and should be adjusted to the result of the culture if the infections does not improve or gets worse. Staphylococcus aureus is isolated 40 to 50%, with resistance to methicillin in 30 to 40%. Choice antibiotics are vancomycin, tigecycline and linezolid. Osteomyelitys is a deep moderate infection, characterized by purulent discharge, bone exposure, “sausage toe” or positive probe-to bone test. Definite diagnosis is reached with biopsy or magnetic nuclear resonance. Hospitalization is indicated in severe cases of hemodynamically and metabolically unstable patients.
Conclusions: Diabetic foot infections can go from mild to severe and end in partial amputation of the feet, the extremity, or even cause death of the patient. Systematic and integral care based on the San Elian classification and score is required.


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