Diabetic foot infection

Diabetic foot infection is a common, serious, and potentially life-threatening complication of diabetes mellitus. It is a result of the combination of factors, including peripheral neuropathy, peripheral arterial disease, and immune system deficiencies. Diabetic foot infections can range from simple, superficial cellulitis to complex infections involving deep tissues and bone. Proper management of these infections is critical to prevent amputation of the affected limb.

Etiology and Pathophysiology

Diabetic foot infections are primarily caused by the direct invasion of pathogens into the foot tissues. The most common pathogens include Staphylococcus aureus, Streptococcus spp., and a variety of Gram-negative bacteria. The risk of infection is significantly increased by factors such as:

• Peripheral neuropathy, which reduces sensation in the feet, leading to unrecognized trauma and injuries.
• Peripheral arterial disease, which impairs blood flow and oxygen delivery to the feet, hindering wound healing.
• Immune dysfunction, which is common in individuals with diabetes, reducing the body's ability to fight off infections.

Clinical Presentation

Patients with diabetic foot infections may present with a variety of symptoms, including:

• Redness, warmth, and swelling of the affected area
• Pain or tenderness
• Purulent discharge (pus) from the wound
• Fever or chills in more severe cases

Diagnosis

Diagnosis of a diabetic foot infection is based on clinical assessment and may be supported by:

• Laboratory tests, including white blood cell count and markers of inflammation like C-reactive protein (CRP)
• Microbiological cultures of wound discharge to identify the causative organisms
• Imaging studies, such as X-rays, to detect bone involvement

Treatment

The treatment of diabetic foot infections involves a multidisciplinary approach, including:

• Antibiotics to target the specific pathogens identified
• Surgical intervention for debridement of necrotic tissue or abscess drainage
• Optimization of blood glucose levels to aid in healing
• Wound care management, including regular dressing changes and off-loading of pressure from the affected area

Prevention

Preventive measures are crucial in reducing the risk of diabetic foot infections and include:

• Regular inspection and care of the feet
• Wearing appropriate footwear to minimize trauma
• Controlling blood sugar levels to reduce the risk of neuropathy and arterial disease
• Regular check-ups with healthcare professionals to assess foot health

Complications

If not properly managed, diabetic foot infections can lead to severe complications, including:

• Osteomyelitis, or bone infection
• Gangrene, necessitating amputation
• Sepsis, a life-threatening response to infection