Diabetic foot infection; symptoms and treatment

Diabetic foot infection

A high blood glucose level of a diabetic patient affects his immune system and increases the chances of diabetic foot infection. Uncontrolled diabetes causes serious infection of the foot. In diabetic patients, blood flow is limited and traffic of white blood cells to the site of infection is restricted.

Pathogens like Gram-positive bacteria (Staphylococcus aureus and beta-hemolytic streptococci) are the most common in mild and moderate infection. Severe, chronic, or previously treated infections are often polymicrobial.
The diagnosis of diabetic foot infection is based on the clinical signs and symptoms of inflammation.

Tissue specimens obtained from wound or bone biopsy are preferred for diagnosis. Foot infection is associated with high morbidity and risk of removal of an affected limb (limb amputation).

Pathophysiology

Neuropathy, vasculopathy, and immunopathy are the factors causing diabetic foot infection. Neuropathy is a prominent risk factor. Motor neuropathy is associated with muscle weakness leading to deformities. Vasculopathy causes changes in blood flow which elevates the skin temperature.

As a result diabetic foot becomes dry, leading to a portal for infection. Immunopathy leads to the disability of white blood cells to reach the infected site and potentiates a normal inflammatory response. This is the reason the diabetic patients are susceptible to the infection; especially the lower limb.
Diabetic angiopathy is another risk factor. It develops the infection into diabetic foot ulcers. Angiopathy may occur in large arteries as well as in small arteries. Larger arteries calcification is called
macroangiopathy and small arteries capillary basement membranes thickening are called microangiopathy; this can lead to impaired microcirculation.

Symptoms of Diabetic foot infection

Symptoms of diabetic foot infection include;
 Fever
 skin rash
 sweating
 Pain
 Redness or swelling
 Wound or cut (difficult to heal)
 Nausea, vomiting, or diarrhea

Treatment

Antibiotics are required to treat the infection. But the treatment is based on the results of the susceptibility test and tissue culture. These results help to manage the choice of antibiotic, route of administration and duration of therapy.

Mild soft tissue infection can be treated effectively with oral antibiotics. Agents such as cephalexin, dicloxacillin, amoxicillin-clavulanate, or clindamycin are effective choices Intravenous treatment for Severe soft tissue infection is given with ciprofloxacin plus clindamycin; piperacillin/tazobactam. Antibiotic treatment should last from one to four weeks for soft tissue infection and six to 12 weeks for osteomyelitis. If you see the improvement with the treatment then it is ok, otherwise, there is a need to review culture or susceptibility test results.
Surgical Treatment is recommended in deep diabetic foot infection. Foot surgery may be simple incision or drainage or amputation depending upon the condition of the foot.

Management

In case of severe infection hospitalize your patient to stabilize metabolic status. It is better to Consider surgical consultations. Culture wound sample and possibly blood sample helps to diagnose and give a view of what antibiotic therapy is suited. In the case of mild to moderate infection outpatient is suitable. Start treatment after Culture wound
sample, Gram stain and Ensure proper wound care.