Diabetic Foot Infection

Abstract

Diabetes is a worldwide disease. Diabetic foot infection is one of the most important complications of diabetes. It may lead to gangrene and amputation of the lower extremities. Peripheral neuropathy, peripheral arterial diseases in addition to immunosuppression contribute to the development of diabetic foot infection. Diabetic foot ulcers are classified according to the size of the ulcer in addition to its depth, site and appearance. Gram-positive cocci especially Staphylococcus aureus is the predominant bacterial pathogen that infect diabetic foot ulcer. However, Gram-negative bacteria and anaerobes are involved in chronic infections. The emergence of multidrug resistant bacteria and the formation of biofilms in diabetic foot ulcers complicate their treatment. Treatment of diabetic foot ulcer depends on medical and surgical intervention. Surgical removal of necrotic and unhealthy tissues, pressure offloading, revascularization and selection of proper wound dressing are important tools in the treatment of diabetic foot ulcers. For choice of the properantibiotic therapy, some factors must be taken into consideration such as the wound culture results, the severity of infection and the predominant bacteria. Staphylococcus aureus especially methicillin resistant Staphylococcus aureus, Gram-negative bacteria in most moderate and severe infections and obligate anaerobes in gangrenous foul smelling wounds should be targeted. Some adjunctive treatments may be helpful such as hyperbaric oxygen therapy, human skin equivalent and granulocyte-colony stimulating factor. Biofilms can be targeted by inhibition of adhesion, physical debridement, electrical stimulation of matrix penetration and quorum sensing inhibition.