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Image by Jeremy Bishop

​Diabetic Foot  Infection

The global prevalence adults living with diabetes mellitus (DM) expected to reach 571 million by 2025. 

Around 1/3 of patients with diabetes are likely to develop a diabetic foot ulcers (DFU) and approximately half of all DFUs may become infected. (2)


Chronic non-healing ulcers are a significant medical problem, and the incidence of these wounds is to increase as the population ages. Each year several patients with diabetes will develop a foot ulcer, and 15-25% will develop a foot ulcer at least once in their lifetime.(5) Not all patients with diabetes are at risk for ulceration. 


DFU results from a complex interaction of a number of risk factors. The neuropathy (with alterations in motor, sensitive and autonomic functions) has the central role, causing ulceration because of trauma or excessive pressure in a deformed foot without protective sensibility. Once broken the protective layer of skin, deep tissues are exposed to bacterial colonization. Infection is facilitated by the immunological deficits, especially neutrophils, related to DM and rapidly progresses to the deep tissues.(3)


The key factors for developing diabetic foot ulcers are peripheral neuropathy, foot deformity, peripheral arterial disease, previous foot ulceration and previous amputation.


Because of the various factors involved in the development and progress of an ulcer, treatment is complex and needs to be multidisciplinary. Management of patients with DFU includes initial wound assessment, restoration of blood flow as needed, identification and treatment of infection, cleansing and debridement of devitalized tissue, antibiotics, and amputation. (5)


Chronic wounds that fail to heal are a common complication of diabetes mellitus and the most common precipitating reason for nontraumatic lower limb amputation. In a recent study from the United Kingdom, 1 year after diagnosis 55% of patients with DFI were still infected and almost 15% had undergone amputation.(1) Around 10% of patients die due to major amputations, and more than 70% of the patients with diabetes-related amputations will die within 5 years. (3)

Even when an ulcer heals, recurrence is high, with recurrence rates of around 40% within 1 year after initial healing of the ulcers, almost 60% within 3 years, and 65% within 5 years. (3)


Topical antibacterial products are often used in conjunction with dressings, as bacterial colonization of DFU is common and can impair wound healing. 

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