"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 swelli
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Infectious Diseases Society of America