DOCSLIB.ORG

Osteomyelitis in Diabetic Foot Ulcers: the Malaysian Experience

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Osteomyelitis in Diabetic Foot Ulcers: the Malaysian Experience Clinical practice Osteomyelitis in diabetic foot ulcers: the Malaysian experience Osteomyelitis is defined as an inflammation of the bone marrow. Approximately 20% of patients with diabetes will develop osteomyelitis and it is linked to high rates of mortality, morbidity and amputation. Diagnosing osteomyelitis associated with a diabetic foot can be challenging as it is difficult to identify the infection in its initial phase and there is often Authors: symptom and clinical manifestation variability. As there are no standardised Harikrishna KR Nair, Sylvia SY Chong tests or criteria for diagnosing osteomyelitis, it may be helpful to obtain a patient’s complete history of symptoms, including physiological state (risk factors) with clinical manifestation, laboratory tests, imaging and blood or bone cultures to come to a final diagnosis. This article looks at some of the tests that can be used in the diagnosis process. he importance of wound irrigation and As seen below, Lew and Waldvogel (Figure 1) cleansing solutions is often ignored, with Cierny and Mader are two major clinical TWAs Malhotra et al (2014) have shown, classifications for osteomyelitis. According to osteomyelitis is defined as an inflammation Lew and Waldvogel in 1970, osteomyelitis is of the bone marrow. A bacterial infection can classified based (Table 1) on the length of cause inflammation of the bone tissue, which evolution and pathophysiology. can result in inflammatory destruction, necrosis, Cierny and Mader (1984) attempted to bone neoformation, and it can progress into a address some aspects that were not covered chronic or persistent stage (Smith et al, 2006). by Lew and Walvogel’s classification . They Staphylococcus aureus is the most common classified osteomyelitis by anatomical stages pathogenic organism isolated in osteomyelitis, according to bone infection and the type of although a variety of organisms can cause this host health status, depending on the patient’s disease, as outlined by Lew and Woldvogel (2015). clinical conditions (Table 2). Harikrishna KR Nair is Head of Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur; Sylvia SY Chong is a Research Assistant, Wound Care Unit, Department Figure 1. Lew and Waldvogel with Cierny and Mader are two major clinical classifications of Internal for osteomyelitis Wounds Asia 2021 | Vol 4 Issue 1 | ©Wounds Asia 2021 | www.woundsasia.com 19 Clinical practice Table 1. The Lew and Waldvogel osteomyelitis classification system Duration of infection Description Acute Initial episodes of osteomyelitis with the presence of oedema, pus formation, vascular congestion and thrombosis of the small vessels Chronic Recurrence of acute cases with large areas of ischemia, necrosis and bone sequestra Mechanism of bone infection Description Hematogenous Commonly seen in children and occurs through secondary infection when bacterial is transported through the blood Contiguous Bacterial inoculation from an adjacent focus, e.g. post-traumatic osteomyelitis, or infections related to prosthetic devices Associated with vascular insufficiency Infections affecting the feet in patients with diabetes, hanseniasis or peripheral vascular insufficiency Table 2. The Cierny and Mader osteomyelitis classification system Anatomical stage Description 1 Medullary Infection restricted to the bone marrow 2 Superficial Infection restricted to cortical bone 3 Localised Infection with clearly defined edges and bone stability preserved 4 Diffuse Infection spread to the entire bone circumference, with stability before or after debridement Host health status Description A Host healthy Patients without comorbidities Bl Local Smoking, chronic lymphedema, venous stasis, arthritis, large scars, fibrosis compromise by radiotherapy Bs Systemic Diabetes mellitus, malnutrition, renal or hepatic failure, chronic hypoxia, compromise neoplasms, extremes of age C Poor clinical Surgical treatment will have a higher risk than the osteomyelitis itself conditions Hematogenous osteomyelitis is most are Staphylococcus aureus (Asmar, 1992). As commonly seen in infants and children, and reported by Ramsey et al (1999) and Lavery et usually involves the metaphysis of long bones, al (2009), about 20% of osteomyelitis cases are particularly the femur and tibia. Metaphyseal acute hematogenous osteomyelitis. Of these, spongiosa contains abundant blood vessels children under the age of 5 account for 50%. with leaky endothelium and a sluggish flow This accumulates up to 85% for cases involving that ends in capillary loops and provides a children under the age of 17, as stated by suitable environment for bacteria growth, Cierny and Mader (1984). as reported by Whyte and Bielski (2016). In The most common infection site is the children under the age of one, there have vertebrae, but it can also occur in the pelvis, been cases of osteomyelitis affecting the clavicle and long bones, and, as reported by epiphysis due to the connection of blood Arciola et al (2005), only 2–7% of adults have vessels passing through the metaphysis to this condition. As Rao et al (2011) have shown, the epiphysis. As shown by McPherson (2002), hematogenous osteomyelitis is usually an acute Liao et al (2005), and Qadir et al (2010), in disorder and primarily treated conservatively. new-borns the most common pathogens are On the other hand, as stated by Lew and Streptococcus agalactiae, Escherichia coli and Waldvogel in 1970, chronic osteomyelitis is Klebsiella pneumonia, while in children the characterised by progressive reoccurrence or common pathogens across all age groups multiple episodes of acute osteomyelitis at the 20 Wounds Asia 2021 | Vol 4 Issue 1 | ©Wounds Asia 2021 | www.woundsasia.com Figure 2. X Rays with bony erosions, subluxations, soft tissue swellings etc and pictures of the wounds with bone exposed or probe test positive with osteomyelitis are shown in a–c a. Patients with osteomyelitis and chronic wounds currently undergoing treatment under the Wound Care Unit, Hospital Kuala Lumpur b. Patients with osteomyelitis and chronic wounds currently undergoing treatment under the Wound Care Unit, Hospital Kuala Lumpur c. Patients with osteomyelitis and chronic wounds currently undergoing treatment under the Wound Care Unit, Hospital Kuala Lumpur same site, which can lead to bone necrosis (Lew in patients with diabetes, as stated by Sia and and Waldvogel, 2004). Berbari (2006). In elective trauma surgery, Other entry routes of infection are secondary close fractures and first- to third-degree open to the direct inoculation of bacteria into fractures had 1–5% and 3–50% of contagious the bone tissue. The can occur in acute infection respectively, as reported by Gustilo trauma (an open fracture) and surgery (with et al (1990). As Parvazi et al (2008) have shown, or without implantation), as well as poor early infections are expected in 0.5% to 2% peripheral vascular supply with infection of of primary hip and knee replacement cases, the surrounding tissues. This is especially seen and more than 20% of septic revisions and Wounds Asia 2021 | Vol 4 Issue 1 | ©Wounds Asia 2021 | www.woundsasia.com 21 CaseClinical reports practice 5% of aseptic revisions have deep infections. clinical manifestation variability. As Arias et Generally, infectious complications occur in al (2019) have shown, because there are no 5% of traumatic and orthopaedic implants standardised tests or criteria for diagnosing during the lifetime of the implant (Trampuz and osteomyelitis, it may be helpful to see a patient’s Zimmerli, 2006). complete history of symptoms, including Contiguous spread of pathogens from physiological state (risk factors) with clinical infected diabetic foot ulcers (DFU) to the manifestation, laboratory tests, imaging, and bone is the pathogenesis of osteomyelitis blood or bone cultures to come to a final in a diabetic foot. Bacteria induce an acute diagnosis. Furthermore, patients with diabetes inflammatory reaction during infection of the and peripheral neuropathy are also prone to bone and the bacteria and inflammation affect developing Charcot neuro-osteoarthropathy, the periosteum and spread in the bone, causing which closely resembles and may co-exist with bone necrosis. Lifting of the periosteum further diabetic foot-associated osteomyelitis (Berendt impairs the blood supply to the affected bone, et al, 2008). causing segmental bone necrosis known as a Clinical suspicion is very important when sequestrum. In the chronic stage, numerous commencing a medical investigation for inflammatory cells and their release of cytokines osteomyelitis. A thorough assessment of the stimulate osteoclastic bone resorption, foot or lower extremity should be performed, ingrowth of fibrous tissue, and the deposition including examination of the ulcer, presence of of reactive new bone in the periphery. When peripheral neuropathy (present in 88% of DFUs), the newly deposited bone forms a sleeve of peripheral vascular disease (present in 45–65% living tissue around the segment of devitalised of DFUs), and the extent of any underlying infected bone, it is known as an involucrum. infection (Nair, 2017). Infected DFUs usually As Rosenberg (2010) has shown, a rupture of have purulent secretions or at least two signs of a subperiosteal abscess may lead to a soft- inflammation, as stated by Giurato et al (2017) tissue abscess and the eventual formation of a and Jeffcoate and Lipsky (2004), yet diabetic draining sinus. foot-associated osteomyelitis can occur without As reported in several publications
Load more

Recommended publications
  • Empiric Antimicrobial Therapy for Diabetic Foot Infection
    Empiric Antimicrobial Therapy for Diabetic Foot Infection (NB Provincial Health Authorities Anti-Infective Stewardship Committee, September 2019) Infection Severity Preferred Empiric Regimens Alternative Regimens Comments Mild Wound less than 4 weeks duration:d Wound less than 4 weeks duration:e • Outpatient management • Cellulitis less than 2 cm and • cephalexin 500 – 1000 mg PO q6h*,a OR • clindamycin 300 – 450 mg PO q6h (only if recommended ,a • cefadroxil 500 – 1000 mg PO q12h* severe delayed reaction to a beta-lactam) without involvement of deeper • Tailor regimen based on culture tissues and susceptibility results and True immediate allergy to a beta-lactam at MRSA Suspected: • Non-limb threatening patient response risk of cross reactivity with cephalexin or • doxycycline 200 mg PO for 1 dose then • No signs of sepsis cefadroxil: 100 mg PO q12h OR • cefuroxime 500 mg PO q8–12h*,b • sulfamethoxazole+trimethoprim 800+160 mg to 1600+320 mg PO q12h*,f Wound greater than 4 weeks duration:d Wound greater than 4 weeks duratione • amoxicillin+clavulanate 875/125 mg PO and MRSA suspected: q12h*,c OR • doxycycline 200 mg PO for 1 dose then • cefuroxime 500 mg PO q8–12h*,b AND 100 mg PO q12h AND metroNIDAZOLE metroNIDAZOLE 500 mg PO q12h 500 mg PO q12h OR • sulfamethoxazole+trimethoprim 800+160 mg to 1600/320 mg PO q12h*,f AND metroNIDAZOLE 500 mg PO q12h Moderate Wound less than 4 weeks duration:d Wound less than 4 weeks duration:e • Initial management with • Cellulitis greater than 2 cm or • ceFAZolin 2 g IV q8h*,b OR • levoFLOXacin 750
    [Show full text]
  • Morganella Morganii
    Morganella morganii: an uncommon cause of diabetic foot infection Tran Tran, DPM, Jana Balas, DPM, & Donald Adams, DPM, FACFAS MetroWest Medical Center, Framingham, MA INTRODUCTION LITERATURE REVIEW RESULTS RESULTS (Continued) followed in both wound care and podiatry clinic. During his Diabetic foot ulcers are at significant risk for causing Gram- Morganella morganii is a facultative gram negative anaerobic The patient was admitted to the hospital for intravenous stay in a rehabilitation facility, the patient developed a left negative bacteraemia and can result in early mortality. bacteria belongs to the Enterobacteriacea family and it is Cefazolin and taken to the operating room the next day heel decubitus ulcer. The left second digit amputation site Morganella morganii is a facultative Gram-negative anaerobe beta-lactamase inducible. It becomes important when it where extensive debridement of nonviable bone and soft has greatly reduced in size, with most recent measurements commonly found in the human gastrointestinal tract as manifests as an opportunistic pathogenic infection elsewhere tissue lead to amputation of the left second digit (Image 1). being 1.5 x 1.0 x 0.4 cm with granular base and the decubitus normal flora but can manifest in urinary tract, soft tissue, and in the body. The risk of infection is particularly high when a Gram stain showed gram negative growth and antibiotics ulcer is stable. abdominal infections. M. morganii is significant as an patient becomes neutropenic that can make a patient more were changed to Zosyn. Intraoperative deep tissue cultures infectious opportunistic pathogen. In diabetics it is shown to susceptible to bacteremia. Immunocompromised patients are grew M.
    [Show full text]
  • A Clinical Practice Guideline for the Use of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers CPG Authors: Enoch T
    UHM 2015, VOL. 42, NO. 3 – CLINICAL PRACTICE GUIDELINE FOR HBO2 TO T REAT DFU A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers CPG Authors: Enoch T. Huang, Jaleh Mansouri, M. Hassan Murad, Warren S. Joseph, Michael B. Strauss, William Tettelbach, Eugene R. Worth UHMS CPG Oversight Committee: Enoch T. Huang, John Feldmeier, Ken LeDez, Phi-Nga Jeannie Le, Jaleh Mansouri, Richard Moon, M. Hassan Murad CORRESPONDING AUTHOR: Dr. Enoch T. Huang – [email protected] ______________________________________________________________________________________________________________________________________________________ ABSTRACT BACKGROUND: The role of hyperbaric oxygen (HBO2) for RESULTS: This analysis showed that HBO2 is beneficial in the treatment of diabetic foot ulcers (DFUs) has been preventing amputation and promoting complete healing examined in the medical literature for decades. There are in patients with Wagner Grade 3 or greater DFUs who have more systematic reviews of the HBO2 / DFU literature than just undergone surgical debridement of the foot as well as there have been randomized controlled trials (RCTs), but in patients with Wagner Grade 3 or greater DFUs that none of these reviews has resulted in a clinical practice have shown no significant improvement after 30 or more guideline (CPG) that clinicians, patients and policy-makers days of treatment. In patients with Wagner Grade 2 or can use to guide decision-making in everyday practice. lower DFUs, there was inadequate evidence to justify the use of HBO2 as an adjunctive treatment. METHODS: The Undersea and Hyperbaric Medical Society (UHMS), following the methodology of the Grading of CONCLUSIONS: Clinicians, patients, and policy-makers Recommendations Assessment, Development and Evalua- should engage in shared decision-making and consider tion (GRADE) Working Group, undertook this systematic HBO2 as an adjunctive treatment of DFUs that fit the criteria review of the HBO2 literature in order to rate the quality of outlined in this guideline.
    [Show full text]
  • Diabetic Foot Infections Download
    ARTICLE DIABETIC FOOT INFECTIONS OPPORTUNITIES AND CHALLENGES IN CLINICAL RESEARCH Diabetic foot infections (DFI) are a frequent and complex secondary complication of diabetes that inflict a substantial financial burden on society and are associated with the potential for serious health consequences. The prevalence of DFI is significant, considering that more than 382 million people are living with diabetes worldwide, of which 25% will experience at least one diabetic foot ulcer and approximately 58% of these are likely to become clinically infected.1,2 As such, diabetic foot complications continue to be responsible for the majority of diabetes-related hospitalizations and lower extremity amputations as well as pose a serious risk for death related to infection. Unfortunately, guidelines regarding the diagnosis and treatment of DFI are not specific.1 Additionally, there is a lack of uniformity in clinical trials involving DFI. Differences in design, terminology, and clinical and microbiological outcome measurements pose significant challenges to comparing results among randomized controlled trials (RCT).3 Thus, research in diagnosis, management, and therapy development, as well as development of standardized guidelines for upcoming studies need to be addressed in order to improve the prognosis of DFI patients. AN AT-RISK POPULATION Infection by invading pathogenic organisms is of particular concern for the diabetic population. Diabetes mellitus, a metabolic condition characterized by prolonged elevated blood sugar as a result of inadequate and/or defective insulin production, triggers many downstream metabolic pathways leading to inflammation, nerve damage, circulatory dysfunction, impaired signaling and an altered immune system. The multifactorial nature of diabetes results in diminished wound healing that predisposes diabetics to foot ulcers with the potential for infection.
    [Show full text]
  • Management of Diabetic Foot Infections
    Médecine et maladies infectieuses 37 (2007) 14–25 http://france.elsevier.com/direct/MEDMAL/ Clinical practice guidelines Management of diabetic foot infections Short text Disponible sur internet le 30 novembre 2006 Organized by the Société de Pathologie Infectieuse de Langue Française (SPILF) with the participation of the following scientific societies: Association de Langue Française pour l'Étude du Diabète et des Maladies Métaboliques (ALFE- DIAM), Société Française de Chirurgie Vasculaire, Société Française de Microbiologie, Collège Français de Pathologie Vasculaire Société de Pathologie Infectieuse de Langue Française President: Jean-Paul Stahl (Maladies infectieuses et tropicales. CHU de Grenoble, BP 217, 38043 Grenoble cedex. Tel.: +33 (0) 4 76 76 52 91; fax: +33 (0) 4 76 76 55 69. E-mail: [email protected]). Consensus and guidelines board of the Société de Pathologie Infectieuse de Langue Française Christian Chidiac (coordinator), Jean-Pierre Bru, Patrick Choutet, Jean-Marie Decazes, Luc Dubreuil, Catherine Leport, Bruno Lina, Christian Perronne, Denis Pouchain, Béatrice Quinet, Pierre Weinbreck Organization committee Chairman: Louis Bernard (Maladies infectieuses et tropicales. Hôpital Raymond Poincaré, 104, boulevard Raymond Poincaré, 92380 Garches. Tel.: +33 (0) 1 47 10 77 60; fax: +33 (0) 1 47 10 77 67. E-mail: [email protected]). Organization committee members Jean-Pierre Chambon, CHRU, Hôpital Claude-Huriez, Lille, Vascular Surgery David Elkharrat, Hôpital Ambroise-Paré, Boulogne, Emergency Room Georges
    [Show full text]
  • Ischaemic Diabetic Foot Perspectives on Long-Term
    Faculty of Medicine University of Helsinki ISCHAEMIC DIABETIC FOOT PERSPECTIVES ON LONG-TERM OUTCOME Milla Kallio DOCTORAL DISSERTATION To be presented for public discussion, with the permission of the Faculty of Medicine of the University of Helsinki, in Auditorium 1, Metsätalo, on the 14th of August, 2020 at 12 noon. Helsinki 2020 Supervised by: Professor Maarit Venermo University of Helsinki Department of Vascular Surgery Helsinki University Hospital, Helsinki, Finland Professor Erkki Tukiainen University of Helsinki Department of Plastic Surgery Helsinki University Hospital, Helsinki, Finland Professor emeritus Mauri Lepäntalo Helsinki University Hospital, Helsinki, Finland Reviewed by: Docent Eva Saarinen Centre for Vascular Surgery and Interventional Radiology Tampere University Hospital, Tampere, Finland Docent Ilkka Kaartinen Department of Plastic Surgery Tampere University Hospital, Tampere, Finland Discussed with: Professor Mauro Gargiulo Head of the Department of Experimental, Diagnostic and Speciality Medicine (DIMES), University of Bologna, Bologna, Italy The Faculty of Medicine uses the Urkund system (plagiarism recognition) to examine all doctoral dissertations. ISBN978-951-51-6295-3(nid.) ISBN 978-951-51-6296-0 (PDF) Unigrafia Helsinki 2020 To individuals who live or work with chronic ulcers CONTENTS ORIGINAL PUBLICATIONS ........................................................................................................ 6 ABBREVIATIONS AND DEFINITIONS ........................................................................................
    [Show full text]
  • Download the PAD Guideline
    Received: 1 February 2019 Revised: 1 May 2019 Accepted: 20 May 2019 DOI: 10.1002/dmrr.3276 SUPPLEMENT ARTICLE Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update) Robert J. Hinchliffe1 | Rachael O. Forsythe2 | Jan Apelqvist3 | Edward J. Boyko4 | Robert Fitridge5 | Joon Pio Hong6 | Konstantinos Katsanos7 | Joseph L. Mills8 | Sigrid Nikol9 | Jim Reekers10 | Maarit Venermo11 | R. Eugene Zierler12 | Nicolaas C. Schaper13 on behalf of the International Working Group on the Diabetic Foot (IWGDF) 1Bristol Centre for Surgical Research, University of Bristol, Bristol, UK Abstract 2British Heart Foundation/Centre for The International Working Group on the Diabetic Foot (IWGDF) has published Cardiovascular Science, University of evidence-based guidelines on the prevention and management of diabetic foot dis- Edinburgh, Edinburgh, UK 3Department of Endocrinology, University ease since 1999. This guideline is on the diagnosis, prognosis, and management of Hospital of Malmö, Malmö, Sweden peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates 4 Seattle Epidemiologic Research and the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulcera- Information Centre, Department of Veterans Affairs Puget Sound Health Care System and tion have concurrent PAD, which confers a significantly elevated risk of adverse limb the University of Washington, Seattle, WA events and cardiovascular disease. We know that the diagnosis, prognosis, and treat- 5Vascular Surgery, The University of Adelaide, ment of these patients are markedly different to patients with diabetes who do not Adelaide, South Australia, Australia 6Asan Medical Center University of Ulsan, have PAD and yet there are few good quality studies addressing this important sub- Seoul, South Korea set of patients.
    [Show full text]
  • In Diabetic Foot Infections Antibiotics Are to Treat Infection, Not to Heal Wounds
    Review In diabetic foot infections antibiotics are to treat infection, not to heal wounds 1. Introduction † Mohamed Abbas, Ilker Uc¸kay & Benjamin A Lipsky 2. Methods † University of Geneva, Geneva University Hospitals and Medical School, Service of Infectious 3. Difficulty in diagnosing Diseases, Geneva, Switzerland infection in diabetic foot wounds Introduction: Diabetic foot ulcers, especially when they become infected, are 4. When to use antibiotics? a leading cause of morbidity and may lead to severe consequences, such as amputation. Optimal treatment of these diabetic foot problems usually 5. Antibiotic treatment in overt requires a multidisciplinary approach, typically including wound debride- diabetic foot infection ment, pressure off-loading, glycemic control, surgical interventions and 6. Conclusions occasionally other adjunctive measures. 7. Expert opinion Areas covered: Antibiotic therapy is required for most clinically infected wounds, but not for uninfected ulcers. Unfortunately, clinicians often prescribe antibiotics when they are not indicated, and even when indicated the regimen is frequently broader spectrum than needed and given for longer than necessary. Many agents are available for intravenous, oral or topical therapy, but no single antibiotic or combination is optimal. Overuse of antibi- otics has negative effects for the patient, the health care system and society. Unnecessary antibiotic therapy further promotes the problem of antibiotic resistance. Expert opinion: The rationale for prescribing topical, oral or parenteral anti- biotics for patients with a diabetic foot wound is to treat clinically evident infection. Available published evidence suggests that there is no reason to prescribe antibiotic therapy for an uninfected foot wound as either prophy- laxis against infection or in the hope that it will hasten healing of the wound.
    [Show full text]
  • Emergency Surgery in the Septic Diabetic Patient
    EMERGENCY SURGERY IN THE SEPTIC DIABETIC PATIENT Bradley Castellano, D.P.M. Diabetic patients are often required to undergo ketoacidosis (DKA) delay of the surgery will often be emergency surgical procedures under compromised cir- necessary. At least partial correction of the ketoacidosis cumstances. Emergency surgery including incision and will be necessary prior to initiation of surgery since such drainage of abscesses and amputations of gangrenous patients carry a significant increase in surgical mor- Iimbs are unfortunately relatively frequent situations tality (5). which cannot be significantly delayed. Complicating medical problems must be corrected swiftly and efficient- Fortunately, type I is a less frequently encountered ly so that the patient is able to withstand the stress of class of diabetes. Septic patients with type II diabetes are surgery. The surgical procedure should be well planned less prone to acidosis and this is one of the main and initiated to insure the best result possible in the distinguishing characteristics between the two clinical patient with impaired glucose metabolism. Fortunately, classes (6). Significant alterations in the fluid and recent emphasis has been placed on limb salvage in the electrolyte balance occur insidiously in the type ll diabetic patient with lower extremity infection (1, 2). diabetic patient. Type II patients tend to become dehydrated secondary to hyperosmolarity (7). Extremely PREOPERATIVE MANAGEME NT high glucose levels often in excess of 800 mg/dl are often seen in these patients. Paradoxically these patients will Several complicating factors may exist in the diabetic usually require less insulin to reduce their hyperglycemia patient scheduled for emergency podiatric surgery. (3,7).
    [Show full text]
  • Management of Diabetic Foot Sepsis
    Clinical Practice Guideline MANAGEMENT OF DIABETIC FOOT SEPSIS LAST UPDATED: September 2, 2010 NOTE: Special consideration: Referral to the High Risk Foot Clinic, National Diabetic Centre or Hospital in the Home (HITH) should be considered for management of diabetic foot sepsis. Definition: Management of Diabetic Foot Sepsis Parameters of the Guideline: • Target population: Diabetic patients with foot sepsis • Patient Groups specifically excluded from Guideline: Juvenile diabetics • Contra-Indications: None Definitions of Terms: • DFS: Diabetic Foot Sepsis • Charcot’s Joint / Foot: Neuropathic osteoarthropathy. Non infective, progressive, painless degeneration of one or more weight bearing joints, with joint dislocation, bone destruction, resorption and eventual deformity. This is closely associated with peripheral neuropathy. • Ankle-Brachial Index: The ratio of systolic blood pressure at the ankle and brachial artery. ABI = P (leg) / P (arm). • Multi-Disciplinary Team: Physician, Surgeon, Dietician, Physiotherapist, Counsellors, Ophthalmologist, Social Worker, Prosthetist, Public Health personnel (specifically zone nurses), Foot Clinic staff and others as needed. Disclaimer: It is important to note that this is a general guideline for treatment and sets forth basic principles of care. Treatment of each patient should be individualized according to particular need. Patients with known or suspected allergies to medication and other peculiar aspects to their presentation should be offered safe alternative modes of therapy. © MOH- Surgical
    [Show full text]
  • Recent Advances in the Treatment of Diabetic Foot
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 6 Ver. III (Jun. 2015), PP 01-05 www.iosrjournals.org Recent Advances in the Treatment of Diabetic Foot Dr. Ravichandra Matcha, M.S., Assistant professor of surgery, Andhra Medical College, Visakhapatnam, India Abstract: As number of Diabetic patients is increasing, different chronic complications of diabetes are also increasing; Chronic Diabetic Foot Ulcer is one of the very important but most neglected complications of Diabetes. Foot ulcers in diabetic patients are not uncommon. Approximately 14% of diabetic ulcers lead to amputation & in most of the cases it is trivial foot ulcer which ultimately leads to amputation. More than 80,000 amputations are performed each year on diabetic patients in India, and around 50% of the people with amputations will develop ulcerations and infections in the contra lateral limb within 18 months. An alarming 58% will have a contra lateral amputation 3-5 years after the first amputation. In addition, the 3-year mortality after a first amputation has been estimated as high as 20-50%, and these numbers have not changed much in the past 30 years, despite huge advances in the medical and surgical treatment of patients with diabetes. But prompt treatment of chronic non healing Diabetic Foot Ulcer with multidisciplinary approach can overall change the clinical outcome in nonhealing DFU .Recent technological advancement combined with better understanding of the wound healing process have resulted in a myriad advanced wound healing modalities in the treatment of diabetic foot ulcers.
    [Show full text]
  • Predictors of Lower-Extremity Amputation in Patients with An
    852 Diabetes Care Volume 38, May 2015 Predictors of Lower-Extremity Kristy Pickwell,1 Volkert Siersma,2 Marleen Kars,1 Jan Apelqvist,3 Amputation in Patients With an Karel Bakker,4 Michael Edmonds,5 Per Holstein,6 Alexandra Jirkovska,´ 7 Infected Diabetic Foot Ulcer Edward Jude,8 Didac Mauricio,9 Alberto Piaggesi,10 Gunnel Ragnarson 11 12 Diabetes Care 2015;38:852–857 | DOI: 10.2337/dc14-1598 Tennvall, Heinrich Reike, Maximilian Spraul,13 Luigi Uccioli,14 Vilma Urbancic,15 Kristien van Acker,16 Jeff van Baal,17 and Nicolaas Schaper1 1Division of Endocrinology, Department of Inter- nal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands 2Research Unit for General Practice and Section of General Practice, Department of Public OBJECTIVE Health, University of Copenhagen, Copenhagen, Infection commonly complicates diabetic foot ulcers and is associated with a poor Denmark 3 outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed Department of Endocrinology, University of Malmo,¨ Malmo,¨ Sweden to determine independent predictors of lower-extremity amputation and the 4International Diabetes Federation, Consultative predictive value for amputation of the International Working Group on the Di- Section and International Working Group on the abetic Foot (IWGDF) classification system and to develop a risk score for predicting Diabetic Foot, Heemstede, the Netherlands 5 amputation. Diabetic Department, Kings College Hospital, London, U.K. 6Copenhagen Wound Healing Centre, Bispebjerg RESEARCH DESIGN AND METHODS Hospital, Copenhagen, Denmark We prospectively studied 575 patients with an infected diabetic foot ulcer pre- 7Diabetes Centre, Institute for Clinical and Exper- senting to 1 of 14 diabetic foot clinics in 10 European countries.
    [Show full text]