Management of diabetic foot infections in the light of recent literature and new international guidelines

ABSTRACT

Introduction: In May 2019 the International Working Group on the Diabetic Foot (IWGDF) launched their quadrennially updated guidelines on the management of diabetic foot infections (DFIs). Concomitantly, the number of new publications regarding DFI increased.

Areas covered: The IWGDF committee developed and addressed key questions and produced evidence-based recommendations related to diagnosing and treating DFIs. This narrative review provides an overview of this new guideline and also of other recently published literature in the field of DFIs.

Expert opinion: The 2019 IWGDF guidelines provide an authoritative, international, evidence-based approach to diagnosing and treating DFIs. The 27 recommendations are supported by systematic reviews of both diagnosis and interventions. Our review of this guideline, along with other recent publications in the field, allows us to offer state-of-the-art guidance for caring for these difficult infections. As the evidence base for management of DFIs remains suboptimal, we need further research to improve the management of DFIs.

KEYWORDS:

• International guidelines
• diabetic foot infections
• osteomyelitis
• treatment failure
• antibiotic therapy
• foot surgery
• infection management

Declaration of interest

Benjamin A. Lipsky chaired the working group that wrote the IWGDF infection guideline.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• The optimal approach to diabetic foot infections remains a challenge for clinicians.

• The recently updated guidelines of the International Working Group of the Diabetic Foot provide clinically practical and evidence-based data on management of these infections.

• Implementing these guidelines in various clinical settings is now a major imperative.

• A lack of published data leaves the best approach to several issues unclear, e.g. the best duration of (post-surgical) antibiotic administration for osteomyelitis, with or without surgical resection; optimal regimens for antibiotic stewardship; the type and effectiveness of bundled interventions; recommended approaches to surgical resections; role of bone histopathology in determining antibiotic treatment; and appropriate empirical antibiotic use in settings with predominant gram-negative pathogens.

• Further research is needed, and underway, with increasing academic interest in this field.

Additional information

Funding

This paper was not funded.