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Description
Infection continues to play a key role in the morbidity associated with the diabetic foot and as an immediate precedent to amputation. Despite its importance, there are many unanswered questions concerning the diagnosis and management of diabetic foot infections (DFIs). Perspectives on treatment have evolved over time, from an age of therapeutic nihilism, through a period of surgical absolutism, to a current debate between advocates of the need for early surgery (especially in osteomyelitis) and those who cite evidence supporting the successful treatment of many cases of DFIs with antibiotics and non-surgical therapies alone.
A search of PubMed using the term 'diabetic foot infection' reveals some 770 references published since 1998, but only 308 publications in the preceding thirty years. The first decade of The Diabetic Foot Journal thus represents the era when the study of DFI finally came of age, including at the level of seeking international consensus on management.
Managing diabetic foot infection
The need for guidelines for managing infection is perhaps all the greater because of the lack of high-quality evidence to dictate treatment. A recent systematic review, produced independently of the guidelines groups, concluded that there was no evidence that any one antibiotic was superior to another in the treatment of infected diabetic foot ulcers (Nelson et al, 2006), but the design and conduct of the studies necessary to resolve this issue poses considerable difficulties. This is, however, only the first of many problems, including the following.
* How can infection best... |
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