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Infection of diabetic foot ulcers is recognized as a major risk factor for amputation of the affected limb and, therefore, prompt diagnosis and treatment is crucial for preventing serious complications. The following general principles are used for the management of infection in patients with diabetic foot ulcers:

• Diagnosis - clinically, infection is suspected by the presence of pus in the wound and other cardinal symptoms that may be present (e.g.,redness; warmth; swelling; pain).

• Wound cultures - all wounds that are clinically suspected to be infected should be cultured and the organisms involved should be identified.

• Debridement - repeated, sharp debridement (surgical removal of dead or infected tissue from a wound) has been shown to be an effective means for promoting healing of diabetic foot ulcers.

• Antibiotic therapy

  • all infected diabetic foot ulcers require antibiotic therapy
  • the initial choice of antibiotics may be selected emperically until the results of bacterial cultures have been determined
  • the final choice of antibiotics should be based on the patient's clinical response and the results of culture and sensitivity studies
  • most mild diabetic foot infections usually respond to a 7-10 day course of antibiotic therapy
  • severe infections (e.g., cellulitis) will usually require a longer duration of antibiotic therapy (up to 3-weeks)

• Osteomyelitis - Infection of the underlying bone (osteomyelitis) is a leading cause of amputation in patients with diabetic foot ulcers. Prompt diagnosis and aggressive treatment are mandatory in order to prevent amputation. Treatment of osteomyelitis involves surgery for resection of the infected bone and 4-6 weeks of parenteral antibiotic therapy directed against the organisms that are responsible for causing the infection.