DMRR special issue: Diabetic foot infection

Infections are a well-known danger in patients with a diabetic foot ulcer.

To limit poor outcomes, adequate diagnosis needs to be followed by adequate treatment. Dr. Peters and Prof. Lipsky describe in two articles the pitfalls and dangers in diagnosis and treatment of diabetic foot infections.

When diagnosing infection, Peters and Lipsky stress clinicians should rely primarily on clinical signs and symptoms of infection obtained via standardized assessment using IWGDF/IDSA criteria, rather than on microbiological data. The purpose of microbiology is identifying the causing organism(s), but various pitfalls should be taken into account: microbiological results can be misleading, since all wounds harbour micro-organisms, and therapy guided by swabs will likely result in overtreatment. The importance of preventing such overtreatment is targeted by Lipsky, who describes the risks of a post-antibiotic era.

The final pitfall described concerns osteomyelitis. Higher diagnostic accuracy is needed to avoid over- or undertreatment. This accuracy may be obtained when treatment decisions will be based on a combination of diagnostic tests, rather than relying on a single test. Another good point to take back to our clinics.