ABSTRACT
Foot infections in patients with diabetes cause substantial morbidity and may lead to amputation. Diabetic foot infections require attention to local and systemic issues and coordinated multidisciplinary management. Aerobic gram-positive cocci, especially S. aureus, are the predominant pathogens. Patients with chronic wounds or who have recently received antibiotics may also be infected with gram-negative or anaerobic pathogens. Wound infections must be clinically diagnosed on the basis of local signs and symptoms of inflammation. Specimens appropriately obtained must be sent for culture prior to starting empirical antibiotic therapy. Tissue specimens obtained by biopsy, ulcer curettage, or drainage are preferred. Infections should be categorized by their severity to determine the degree of risk and the urgency of management. Empirical antibiotic therapy is selected on the basis of the severity and the likelihood of etiological agents. Therapy aimed solely at aerobic gram-positive cocci may be sufficient for mild-to-moderate infections in patients who have not recently received antibiotic. Definitive therapy should be based on the susceptibility data and the clinical response to the empirical regiment. Severe and some moderate infections require pareteral therapy, at least initially. Highly oral bioavailable antibiotics can be used in most mild and moderate infections. Antibiotic therapy should be continued until there is evidence that the infection has resolved but not necessarily until a wound has healed. Surgical evaluation is needed for infections accompanied by a deep abscess, extensive bone or joint involvement, substantial necrosis or gangrene, or necrotizing fasciitis