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Diabetic Foot Infections: Literature Review

Diabetic Foot Infections: Literature Review

Diabetes is a major concern for public health in the United States. With about 23.6 million diabetic people, healthcare professionals have been making efforts to curb further upsurge in this figure. Even then, there are more concerns about diabetic foot infections (DFIs) which are complications that arise due to diabetes. There are quite a number of reasons for this level of concern. First, there is a great number of people who are victims of DFIs. Figures show that of the 23.67 million diabetic Americans, about 20-25% experience DFIs as secondary complications of diabetes. For these people, there has never been much help because of lack of a one-size-fit-all solution to their problems, which are otherwise complex and varied. The existing review of literature shows a lack of consensus on methods of ensuring proper diagnosis and treatment of the DFIs’ complications.

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Most authors report that despite being ineffective as indicated by research, antibiotic therapy and surgery remain the most applied methods for treating DFIs. Benwan, Mullab, and Rotimi (2012) recommend to treat DFIs arising out of diabetes mellitus using antibiotics. More specifically after examining diabetes mellitus in Kuwait these authors advise the use of imipenem, piperacillin-tazobactam and vancomycin. However, they also caution that the disease may be drug-resistant. Charles, Uçkay, Kressmann, Emonet and Lipsky (2015) as well recommend antibiotic therapy to fight DFIs that often thrive in environments that offer conditions that promote development and survival of anaerobes associated with these chronic infections. Surgical treatment, which often ends in amputation, is also provided as a remedy against the spread of DFIs on the body of the affected. Caprioli (2014) recognizes that surgery is another major approach to treating DFIs apart from antibiotic therapy. Research shows that DFIs still remain the primary reason for hospitalization among the diabetes related-cases as well as amputation of lower extremities. However, this author notes that a combination of a number of treatment methods could be essential to help those affected by DFIs, although this combination also results in difficulties and necessitates close diagnosis (p. 156). This complexity is associated with the compliance of the infections to a variety of microorganisms as well as a variety of conditions that are pre-determinants of these infections (Craig & Cherry, 2016; Glaudemans, Uckay, & Lispky, 2015). However, with proper management and treatment DFIs can be treated by first creating a care pathway for diabetic foot problem inpatients, especially those reported to have any skin breaks, inflammation, infection signs, swelling, gangrene among others. The team of professionals with the necessary skills are required to evaluate the response of patients to surgical procedure as well as medical process within six hours of examination. The author also argues that that kind of evaluation assists in determining the need to involve a specialist for surgical or vascular intervention, treatment reviewing due to antibiotic therapy as well as assessing the intervention to protect the patient from spread of the disease to other parts or foot deformities.

Apparently, surgical treatment and amputation for that matter are caused by yet another complication that thwarts efforts to use antibiotics. This is the resistance of some of the causative agents of DFIs. As already discussed from the foregoing, DFIs can be caused by a variety of microorganisms, a fact which goes to tell that this antibiotic therapy may be ineffective. Indeed, many researchers agree on this. Cervantes-García, García-Gonzalez, Reyes-Torres, Resendiz-Albor and Salazar-Schettino (2015) point out categorically at the ineffectiveness of antibiotic therapy in treating a DFI caused by Staphylococcus aureus. These authors posit that S. aureus encourages the emergence of chronic infections and is also resistant to treatment with methicillin. Cervantes-García et al. (2015) recommend surgical treatment for this particular situation. However, this seems a shortcut to other scholars who agree with Cervantes-García and her colleagues on the ineffectiveness of antibiotic therapy. A number of researchers report that antibiotic therapy has failed on many occasions and recommend other alternatives, which do point to adoption of surgery as the last resort, but not after timely, precise and thorough to establish underlying cause for a DFI (Duhon, Hand, Howell, & Reveles, 2016; Fontaine, Bhavan, Talal, & Lavery, 2014; and Glaudemans et al., 2015).

Thus far, there is a need to understand various factors that underlay any DFI, because these infections are not caused by any single microorganism and are not predetermined by one particular condition. On the one hand, male sex and white blood cells are reported by Craig and Cherry (2016) to determine amputation caused by DFIs. On the other hand, Duhon et al. (2016) list peripheral vascular disease and neuropathy as other predetermining conditions for DFIs apart from male sex (p. 199-202). Thus, these researchers advise that treatment measures should be informed by these risk factors as well. This is in agreement with Glaudemans et al.’s (2015) observation that correct diagnosis is the best practice for ensuring proper treatment of diabetic foot infections. Glaudemans et al. (2015) offer additional diagnostic strategies such as soft tissue tests, thermography and imaging tests (p. 753). Concerning microorganisms, the research presents a variety of germs causing DFIs, and most of which are also reported to be antibiotic-resistant. For example, Kabbara and Zgheib (2015) found out that one microorganism that is responsible for DFIs is Raoultella ornithinolytia which is resistant to amoxicillin-clavulanate. Similarly, research has also shown that DFIs caused by S. aureus are resistant to antibiotics, rendering corresponding therapy ineffective in controlling or treating them (Cervantes-García et al., 2015; Radji, Putri, & Fauziyah, 2014). Polymicrobial are as well difficult to treat through administering antibiotics as reported by Lavery, Peters, Armstrong, Wendel, Murdoch and Lipsky (2009). In contrary, Benwan et al. (2012) recommend treating infections of this nature using a variety of antibiotics such as pipercilin-tozabactin, vancomycin, and imipenem. One thing is, however, true; antibiotic therapy is not wholly ineffective. The effectiveness if this approach depends on various factors such as predetermining conditions, duration of an infection as well as the diagnosis that has been set to guide on treatment measures.

Another way to ensure that effective treatment measures are taken is to consider the infection from a mycobacterial point of view (Rahimoon, Alam, & Talpur, 2015). Rahimoon and his colleagues report that gram-negative microbes are more likely to cause or encourage the development of DFIs compared to gram-positive counterparts. More specifically, these authors present a study that shows that Proteus, S. aureus, and Klebsiella are gram-negative microbes that encourage the development of DFIs and are also resistant to antibiotic treatment. As a result, these microbes may lead to the need for amputation through surgery. However, it is not the confirmation of the development of microbes that is of much concern alone. There is also the ability of some of these microbes speeding up the spread of the infections, eventually culminating into chronic illnesses (Raspovic & Wukich, 2014). With frequent hospitalizations, these infections may spread fast and result in further complications as the patient is taken through the treatment continuum (Noor, Khan, & Ahmad, 2016; Lavery et al., 2009).

Based on what has transpired from the literature review in the foregoing, there is yet a consensus to be reached on best-practices when it comes to diagnosing and treating diabetic foot infections (DFIs). While one researchers recommend antibiotic therapy against DFIs, others report that this method of treating is not effective, and they point out to a number of reasons for their position. First, DFIs are caused by a wide range of microorganisms, and this may mean that antibiotics used in a given therapy against an infection can be not appropriate in other cases. This condition may further be complicated by polymicrobial. Second, antibiotics used must be determined considering risk factors, which, in most cases, do not always underlay diagnosis measures. That is why most researchers who are objected to antibiotic therapy recommend an examination of an infection's pathological process such as neuropathy prevalence, as well as distinguishing specific risk aspects that should inform every diagnostic method. In short, proper data assessment compounded with proper classification of any DFI should be the underlying strategies to ensure that appropriate treatment measures are adopted. Whatever the course of action is, the prevalence of predetermining conditions or rather risk factors, duration a patient has been struggling with an infection and the approaches adopted by physicians to treat these patients have consequences in the life of a patient (Roberts & Simon, 2012). Some of these may be positive while some may complicate issues even further. There is, therefore, an urgent need to develop a strategy that would help healthcare professionals and nurses in particular, because they are often charged with a responsibility of taking the patient through healthcare continuum, adopting proper and most appropriate measures during the treatment of DFIs.

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