Microbiology and Treatment of Diabetic Foot Infection

The diagnosis and treatment of diabetic foot infection should be based on an assessment of the severity of infection using a well-studied approach such as the International Working Group on the Diabetic Foot (WGDF)/Infectious Diseases Society of America (IDSA) classification scheme. The major pathogens causing diabetic foot infection can be anticipated based on the severity of infection and further informed by additional patient specific factors such as failed prior antibiotic treatment or extensive health-care exposure. Establishing a microbiologic diagnosis is key to informing antibiotic therapy, particularly in those patients with limb threatening infection or risk factors for infection caused by antibiotic resistant pathogens. Surgical resection of infected bone has historically been the standard treatment of osteomyelitis; however, in carefully selected patients, medical therapy may also be an effective strategy. The duration of antibiotic therapy for soft tissue infection is based on the severity disease and for osteomyelitis on whether treatment utilizes medical therapy alone or includes complete surgical resection of involved bone. Long-term healing of foot ulcers to prevent future episodes of infection and the preservation of a weight-bearing foot remain core goals requiring collaboration across a multidisciplinary team.