Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Correct treatment of common diabetic foot infections can reduce amputations

IDSA diabetic foot infection guidelines suggest multidisciplinary team approach is best


Diabetic foot complications are the most common cause of lower extremity amputations and half of all patients who have a foot amputated die within five years.

Most amputations can be prevented with proper care of diabetic foot infections, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

A multi-disciplinary team – including infectious diseases specialists, podiatrists, surgeons and orthopedists – can best address the complicated care of diabetic foot infections, the guidelines note.

Diabetic foot infections are an increasingly common problem, but proper care can save limbs and, ultimately, lives, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

Poor treatment of infected foot wounds in people with diabetes can lead to lower extremity amputation, and about 50 percent of patients who have foot amputations die within five years – a worse mortality rate than for most cancers. But about half of lower extremity amputations that aren't caused by trauma can be prevented through proper care of foot infections, note the new IDSA diabetic foot infections guidelines, which are being published today in the journal Clinical Infectious Diseases.

Because people with diabetes often have poor circulation and little or no feeling in their feet, a sore caused by a rubbing shoe or a cut can go unnoticed and worsen. As many as one in four people with diabetes will have a foot ulcer – an open sore – in their lifetime. These wounds can easily become infected. Unchecked, the infection can spread, killing soft tissue and bone. Dead and infected tissue must be surgically removed, which, if the infection is extensive, can mean amputation of the toe, foot, or even part of the leg. Nearly 80 percent of all nontraumatic amputations occur in people with diabetes – and 85 percent of those begin with a foot ulcer.

"Lower extremity amputation takes a terrible toll on the diabetic patient," said Benjamin A. Lipsky, MD, chair of the review panel, lead author of the guidelines and professor of medicine at the University of Washington and VA Puget Sound, Seattle. "People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depressed and are at significant risk for a second amputation. Clearly, preventing amputations is vital, and in most cases, possible."

The guidelines emphasize the importance of rapid and appropriate therapy for treating infected wounds on the feet, typically including surgical removal (debridement) of dead tissue, appropriate antibiotic therapy and, if necessary, removing pressure on the wound and improving blood flow to the area. Many patients with foot infections initially receive only antibiotic therapy, which is often insufficient in the absence of proper wound care and surgical interventions, the guidelines note.

Because treatment of diabetic foot infections can be complicated, the best approach is to involve a multidisciplinary team that can assess and address various aspects of the problem, suggest the guidelines, which are a revision and update of IDSA's 2004 diabetic foot infections guidelines.

Research since the previous guidelines shows that many foot infections are treated improperly, including prescribing the wrong antibiotic or not addressing underlying conditions such as peripheral arterial disease.

The new guidelines include 10 common questions with extensive, evidence-based answers, which the panel that wrote the guidelines determined were most likely to help a health care provider treating a patient with diabetes who has a foot wound. The first step is to determine if the wound is infected, which the guidelines note is likely if there are at least two of the following signs: redness, warmth, tenderness, pain or swelling. About half of ulcers are not infected and therefore should not be treated with antibiotics, the guidelines note. People with infections do need antibiotic therapy and those with a severe infection should be hospitalized immediately.

When a foot sore is infected, imaging the foot is usually necessary to determine if the bone is infected. It is also important to perform a culture of the wound to determine the bacteria causing the infection, which will then help guide which antibiotic should be used for treatment. Because of the complexity of diabetic foot infections, the guidelines suggest these patients are best served by a multidisciplinary team, including infectious diseases specialists, podiatrists, surgeons and orthopedists. In rural areas, doctors may be able to use telemedicine to consult with the appropriate experts, Dr. Lipsky said.

"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," said Warren S. Joseph, DPM, co-author of the guidelines and consultant for lower extremity infectious diseases at Roxborough Memorial Hospital, Philadelphia. "The guidelines note that when antibiotics are necessary they should be discontinued when the infection is gone, even if the wound hasn't completely healed."

The voluntary guidelines are not intended to take the place of a doctor's judgment, but rather to support the decision-making process, which must be individualized according to each patient's circumstances.

The 12-member diabetic foot infections guidelines panel comprises experts representing a variety of specialties, including infectious diseases physicians, podiatrists, surgeons and orthopedists. In addition to Drs. Lipsky and Joseph, the panel includes: Anthony R. Berendt, Paul B. Cornia, James C. Pile, Edgar J.G. Peters, David G. Armstrong, H . Gunner Deery, John M. Embil, Adolf W. Karchmer, Michael S. Pinzur, and Eric Senneville.

IDSA has published more than 50 treatment guidelines on various conditions and infections, ranging from HIV/AIDS to Clostridium difficile. As with other IDSA guidelines, the diabetic foot infections guidelines will be available in a smartphone format and a pocket-sized quick-reference edition. A podcast with the lead author will be available at The full guidelines are available free on the IDSA website at

Note: For an advance copy of the diabetic foot infections guidelines, to be published in the June 15 issue of Clinical Infectious Diseases, please contact Laurel White at (312) 558-1770 or The guidelines are embargoed until 12:01 a.m. EDT on May 22, 2012.

Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty.

The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, patient care, prevention, and public health. The Society, which has nearly 10,000 members, was founded in 1963 and is based in Arlington, Va. For more information, see

Laurel White | EurekAlert!
Further information:

More articles from Health and Medicine:

nachricht Scientists develop tiny tooth-mounted sensors that can track what you eat
22.03.2018 | Tufts University

nachricht NIH scientists describe potential antibody treatment for multidrug-resistant K. pneumoniae
14.03.2018 | NIH/National Institute of Allergy and Infectious Diseases

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Researchers Discover New Anti-Cancer Protein

An international team of researchers has discovered a new anti-cancer protein. The protein, called LHPP, prevents the uncontrolled proliferation of cancer cells in the liver. The researchers led by Prof. Michael N. Hall from the Biozentrum, University of Basel, report in “Nature” that LHPP can also serve as a biomarker for the diagnosis and prognosis of liver cancer.

The incidence of liver cancer, also known as hepatocellular carcinoma, is steadily increasing. In the last twenty years, the number of cases has almost doubled...

Im Focus: Researchers at Fraunhofer monitor re-entry of Chinese space station Tiangong-1

In just a few weeks from now, the Chinese space station Tiangong-1 will re-enter the Earth's atmosphere where it will to a large extent burn up. It is possible that some debris will reach the Earth's surface. Tiangong-1 is orbiting the Earth uncontrolled at a speed of approx. 29,000 km/h.Currently the prognosis relating to the time of impact currently lies within a window of several days. The scientists at Fraunhofer FHR have already been monitoring Tiangong-1 for a number of weeks with their TIRA system, one of the most powerful space observation radars in the world, with a view to supporting the German Space Situational Awareness Center and the ESA with their re-entry forecasts.

Following the loss of radio contact with Tiangong-1 in 2016 and due to the low orbital height, it is now inevitable that the Chinese space station will...

Im Focus: Alliance „OLED Licht Forum“ – Key partner for OLED lighting solutions

Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, provider of research and development services for OLED lighting solutions, announces the founding of the “OLED Licht Forum” and presents latest OLED design and lighting solutions during light+building, from March 18th – 23rd, 2018 in Frankfurt a.M./Germany, at booth no. F91 in Hall 4.0.

They are united in their passion for OLED (organic light emitting diodes) lighting with all of its unique facets and application possibilities. Thus experts in...

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

Im Focus: Tiny implants for cells are functional in vivo

For the first time, an interdisciplinary team from the University of Basel has succeeded in integrating artificial organelles into the cells of live zebrafish embryos. This innovative approach using artificial organelles as cellular implants offers new potential in treating a range of diseases, as the authors report in an article published in Nature Communications.

In the cells of higher organisms, organelles such as the nucleus or mitochondria perform a range of complex functions necessary for life. In the networks of...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

International Tinnitus Conference of the Tinnitus Research Initiative in Regensburg

13.03.2018 | Event News

Latest News

Modular safety concept increases flexibility in plant conversion

22.03.2018 | Trade Fair News

New interactive map shows climate change everywhere in world

22.03.2018 | Earth Sciences

New technologies and computing power to help strengthen population data

22.03.2018 | Earth Sciences

Science & Research
Overview of more VideoLinks >>>