Infectious Diseases Society of America.

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61404-X/pdf

Guidelines for the management of adult lower respiratory tract infections ‐ Full version

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61403-8/pdf

Guidelines for the management of adult lower respiratory tract infections - Summary

RecommendationsClassification/diagnosis
1.Diabetic foot infection must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong; low).
2.Assess the severity of any diabetic foot infection using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme (strong; moderate).


Osteomyelitis
3.For an infected open wound, perform a probe-to-bone test; in a patient at low risk for osteomyelitis, a negative test largely rules out the diagnosis, while in a high-risk patient, a positive test is largely diagnostic (strong; high).
4.Markedly elevated serum inflammatory markers, especially erythrocyte sedimentation rate, are suggestive of osteomyelitis in suspected cases (weak; moderate).
5.A definite diagnosis of bone infection usually requires positive results on microbiological (and, optimally, histological) examinations of an aseptically obtained bone sample, but this is usually required only when the diagnosis is in doubt or determining the causative pathogen's antibiotic susceptibility is crucial (strong; moderate).
6.A probable diagnosis of bone infection is reasonable if there are positive results on a combination of diagnostic tests, such as probe-to-bone, serum inflammatory markers, plain X-ray, magnetic resonance imaging (MRI) or radionuclide scanning (strong; weak).
7.Avoid using results of soft tissue or sinus tract specimens for selecting antibiotic therapy for osteomyelitis as they do not accurately reflect bone culture results (strong; moderate).
8.Obtain plain X-rays of the foot in all cases of non-superficial diabetic foot infection (strong; low).
9.Use MRI when an advanced imaging test is needed for diagnosing diabetic foot osteomyelitis (strong; moderate).
10.When MRI is not available or contraindicated, consider a white blood cell-labelled radionuclide scan, or possibly single-photon emission computed tomography (CT) and CT (SPECT/CT) or fluorine-18-fluorodeoxyglucose positron emission tomography/CT scans (weak; moderate).


Assessing severity
11.At initial evaluation of any infected foot, obtain vital signs and appropriate blood tests, debride the wound and probe and assess the depth and extent of the infection to establish its severity (strong; moderate).
12.At initial evaluation, assess arterial perfusion and decide whether and when further vascular assessment or revascularization is needed (strong; low).


Microbiological considerations
13.Obtain cultures, preferably of a tissue specimen rather than a swab, of infected wounds to determine the causative microorganisms and their antibiotic sensitivity (strong; high).
14.Do not obtain repeat cultures unless the patient is not clinically responding to treatment, or occasionally for infection control surveillance of resistant pathogens (strong; low).
15.Send collected specimens to the microbiology laboratory promptly, in sterile transport containers, accompanied by clinical information on the type of specimen and location of the wound (strong; low).


Surgical treatment
16.Consult a surgical specialist in selected cases of moderate, and all cases of severe, diabetic foot infection (weak; low).
17.Perform urgent surgical interventions in cases of deep abscesses, compartment syndrome and virtually all necrotizing soft tissue infections (strong; low).
18.Consider surgical intervention in cases of osteomyelitis accompanied by spreading soft tissue infection, destroyed soft tissue envelope, progressive bone destruction on X-ray or bone protruding through the ulcer (strong; low).


Antimicrobial therapy
19.While virtually all clinically infected diabetic foot wounds require antimicrobial therapy, do not treat clinically uninfected wounds with antimicrobial therapy (Strong; Low)
20.Select specific antibiotic agents for treatment based on the likely or proven causative pathogens, their antibiotic susceptibilities, the clinical severity of the infection, evidence of efficacy of the agent for diabetic foot infection and costs (strong; moderate).
21.A course of antibiotic therapy of 1–2 weeks is usually adequate for most mild and moderate infections (strong; high).
22.Administer parenteral therapy initially for most severe infections and some moderate infections, with a switch to oral therapy when the infection is responding (strong; low).
23.Do not select a specific type of dressing for a diabetic foot infection with the aim of preventing an infection or improving its outcome (strong; high).
24.For diabetic foot osteomyelitis, we recommend 6 weeks of antibiotic therapy for patients who do not undergo resection of infected bone and no more than a week of antibiotic treatment if all infected bone is resected (strong; moderate).
25.We suggest not using any adjunctive treatments for diabetic foot infection (weak; low).
26.When treating a diabetic foot infection, assess for use of traditional remedies and previous antibiotic use and consider local bacterial pathogens and their susceptibility profile (strong; low).

https://onlinelibrary.wiley.com/doi/pdf/10.1002/dmrr.2699

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes.

Name Sequence Exon 2 mG6pc S 5’-TCCCTGTCACCTGTGAG-3’ Exon 5 mG6pc AS 5’-CACAAGAAGTCTTTGTAA-3’ Exon1 mG6pcS 5’-TTACCAAGACTCCCAGGACTG-3’ Exon2 mG6pcAS 5’-GAGCTGTTGCTGTAGTAGTCG-3’ Pck1S 5’-AGCCTTTGGTCAACAACTGG-3’ Pck1AS 5’-TGCCTTCGGGGTTAGTTATG-3’ GcgR S 5’-ACCCAACTATTGCTGGTTGC-3’ GcgR AS 5’-CCATGTTGTCATTGCTGGTC-3’ Hmgcs2 S 5’-CCGTATGGGCTTCTGTTCAG-3’ Hmgcs2 AS 5’-AGCTTTGTGCGTTCCATCAG-3’ mL19S 5’-AGAAGATTGACCGCCATAT-3’ mL19AS 5’-TTCGTGCTTCCTTGGTCTTAGA-3’ CRU G6pc S 5’-TTTGCTATTTTACGTAAATCACCCT-3’  CRU G6pc AS 5’-GTACCTCAGGAAGCTGCCA-3’ CRU Pck1 S 5’-GGCCTCCCAACATTCATTAAC-3’ CRU Pck1 AS 5’-GTAGCTAGCCCTCCTCGCTTTAA-3’ GRU G6pc S 5’-CACCCCTTAGCACTGTAAGCCGTGTG-3’ GRU G6pc AS 5’-GGATTCAGTCTGTAGGTCAACCTAGCCC-3’ GRU Pck1 S 5’-TGCAGCCAGCAACATATGAA-3’

Supplementary table 1

Phase 3 study comparing tigecycline and ertapenem in patients with diabetic foot infections with and without osteomyelitis.

Tigecycline, an expanded broad-spectrum glycylcycline, exhibits in vitro activity against many common pathogens associated with community-acquired pneumonia (CAP), as well as penetration into lung tissues that suggests effectiveness in hospitalized CAP patients. The aim of the present study was to compare the efficacy and safety of intravenous (IV) tigecycline with IV levofloxacin in hospitalized adults with CAP. In this prospective, double-blind, non-inferiority phase 3 trial, eligible patients with a clinical diagnosis of CAP supported by radiographic evidence were stratified by Fine Pneumonia Severity Index and randomized to tigecycline or levofloxacin for 7-14 days of therapy. Co-primary efficacy endpoints were clinical response in the clinically evaluable (CE) and clinical modified intent-to-treat (c-mITT) populations at test-of-cure (Day 10-21 post-therapy). Of the 428 patients who received at least one dose of study drug, 79% had CAP of mild-moderate severity according to their Fine score. Clinical cure rates for the CE population were 88.9% for tigecycline and 85.3% for levofloxacin. Corresponding c-mITT population rates were 83.7% and 81.5%, respectively. Eradication rates for Streptococcus pneumoniae were 92% for tigecycline and 89% for levofloxacin. Nausea, vomiting, and diarrhoea were the most frequently reported adverse events. Rates of premature discontinuation of study drug or study withdrawal because of any adverse event were similar for both study drugs. These findings suggest that IV tigecycline is non-inferior to IV levofloxacin and is generally well-tolerated in the treatment of hospitalized adults with CAP. NCT00081575

/pdf/efficacy-and-safety-of-tigecycline-versus-levofloxacin-for-49iorlrjlf.pdf

Efficacy and safety of tigecycline versus levofloxacin for community-acquired pneumonia

Introduction:
This study was conducted to evaluate the efficacy of tigecycline (TGC) versus levofloxacin (LEV) in hospitalized patients with community-acquired pneumonia (CAP) using pooled data and to perform exploratory analyses of risk factors associated with poor outcome.

https://openrespiratorymedicinejournal.com/VOLUME/7/PAGE/13/PDF/

Nathalie Castaing

Papers

Phase 3 study comparing tigecycline and ertapenem in patients with diabetic foot infections with and without osteomyelitis.

Efficacy and safety of tigecycline versus levofloxacin for community-acquired pneumonia

Tigecycline Versus Levofloxacin in Hospitalized Patients With Community-Acquired Pneumonia: An Analysis of Risk Factors