Diagnosis and Management of Diabetic Foot Infections

| This compendium is a follow-up to the 2018 American Diabetes Association compendium Diagnosis and Management of Diabetic Foot Complications. Whereas the first compendium offered a broad general overview of diabetic foot conditions, this second volume presents a detailed discussion of the prevention and treatment of diabetic foot infections (DFIs), a major contributor to high amputation rates among people with diabetes. The treatise begins from the viewpoint of basic science, describing the impact of infection on the healing process of experimental wounds. There follow overviews of biofilm development in chronic diabetic foot ulcers (DFUs), the microbiology of DFIs, and the crucial role of debridement in ensuring positive outcomes of DFI treatment. Next, the authors provide a practical guide to the diagnosis and clinical management of DFIs. Current controversies regarding the treatment of osteomyelitis are addressed, including the relative value of antibiotics versus surgery and the use of intravenous versus oral antibiotics. The compendium closes with a look at new topical treatments and the role of emerging technologies in infection control. A fter the success and positive reception of the American Diabetes Association’s 2018 compendium Diagnosis and Management of Diabetic Foot Complications (1) the association asked us to proceed with a second volume. The first publication offered a broad general overview of diabetic foot issues, encompassing the etiopathogenesis of complications, screening, and wound classification; management of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs); recognition and treatment of peripheral artery disease (PAD) and Charcot neuroarthropathy; off-loading, wound management, and adjunctive therapies; and maintenance of the foot in remission. In the past few years, there has been a renaissance in diabetic foot care with respect to evidence-based treatments (2). Examples include the LeucoPatch system (3), topical oxygen delivery (4,5), and, for neuroischemic ulcers, sodium octasulfate dressings (6). There has also been progress in the management of DFUs with infection. For example, a randomized controlled trial (RCT) confirmed that treatment with antibiotics is noninferior to local surgery for localized diabetic foot osteomyelitis (DFO) (7). (See related discussion on p. 12.) Most recently, the OVIVA (Oral Versus Intravenous Antibiotics) trial confirmed that, for complex bone and joint infections, oral antibiotic therapy had simDiagnosis and Management of Diabetic Foot Infections Andrew J.M. Boulton, MD, DSc (Hon), FACP, FRCP David G. Armstrong, DPM, MD, PhD Matthew J. Hardman, PhD Matthew Malone, PhD, FFPM RCPS (Glasg) John M. Embil, MD, FACP, FRCPC Christopher E. Attinger, MD Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP (London), FFPM RCPS (Glasg) Javier Aragón-Sánchez, MD, PhD Ho Kwong Li, MBBS, MRCP (UK), DTM&H Gregory Schultz, PhD Robert S. Kirsner, MD, PhD University of Manchester, Manchester, UK University of Miami Miller School of Medicine, Miami, FL Keck School of Medicine of the University of Southern California, Los Angeles, CA Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, CA Hull York Medical School, Hull, UK South Western Sydney Local Health District, Limb Preservation and Wound Research Academic Unit, Ingham Institute of Applied Medical Research, Liverpool, Sydney, NSW, Australia Western Sydney University, School of Medicine, Infectious Diseases and Microbiology, Campbelltown Campus, Sydney, Australia Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada MedStar Georgetown University Hospital, Washington, DC University of Washington School of Medicine, Seattle, WA Green Templeton College, University of Oxford, UK Department of Surgery and Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain Medical Research Council—Centre for Molecular Bacteriology & Infection, London, UK Department of Infectious Disease, Imperial College London, London, UK University of Florida, Gainesville, FL Address correspondence to Andrew J.M. Boulton, ABoulton@med.miami.edu, and David G. Armstrong,