Comprehensive Approach to Diabetic Foot Infections #StateoftheArt #ActAgainstAmputation @CIDJournal

This from our combined multidisciplinary team in Clinical Infectious Diseases

Evaluation and Management of Diabetes-related Foot Infections 

Nicolas W Cortes-PenfieldDavid G ArmstrongMeghan B BrennanMaya FayfmanJonathan H RyderTze-Woei TanMarcos C Schechter

Diabetes-related foot ulcers (DFUs) have a global prevalence of 6.3%, reaching 13% in North America [1]. DFUs have a dismal prognosis, with 5- and 10-year survival rates of approximately 50% and 25%, respectively [23]. Infection, complicating >40% of DFUs, is often the coup-de-grace; nearly half of patients hospitalized with a diabetes-related foot infection (DFI) undergo amputation within 1 year [45]. These risks disproportionately affect Black, Hispanic, Native, rural, and low-income communities [67]. Lower extremity amputations due to DFUs are the third most costly diabetes complication and are feared by many patients more than death [8].

In 2012, the authors of the Infectious Diseases Society of America (IDSA) DFI guidelines declared that “The main problem currently is less our lack of full understanding of the problem as our failure to apply what we know works.” [9] This statement remains accurate a decade later. Multidisciplinary DFI teams can reduce major amputations, and similar teams have dramatically reduced attributable mortality for infective endocarditis [1011]. Despite this, inconsistent and unstructured collaboration between specialists that lead to breakdowns in shared decision-making remains common.

In this narrative review, we bring together experts in infectious diseases, endocrinology, podiatry, and vascular surgery to discuss shared decision-making in DFI care. We provide a focused overview of the comprehensive management of these patients, highlighting modern research spearheaded by our surgical colleagues and contemporary guidance from the International Working Group for the Diabetic Foot (IWGDF), arguably the lingua franca of DFI specialists [12]. Finally, we offer best practices for clinician–clinician and patient–clinician shared decision-making.

Notably, while this review reflects our expert opinion based on data largely published after the now-archived IDSA DFI guidelines, it is not intended to supplant those guidelines. This review is also written from the perspective of US-based clinicians and intended primarily for infectious diseases (ID) specialists. International colleagues may find some of our considerations regarding barriers to care less relevant, and a comprehensive review of surgical decision-making in DFI is outside this article’s scope.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Up ↑

%d bloggers like this:
Verified by MonsterInsights