2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections
Benjamin A. Lipsky,Anthony R. Berendt,Paul B. Cornia,James C. Pile,Edgar J G Peters,David G. Armstrong,H. Gunner Deery,John M. Embil,Warren S. Joseph,Adolf W. Karchmer,Michael S. Pinzur,Eric Senneville +11 more
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TLDR
Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs, and Employing multidisciplinary foot teams improves outcomes.Abstract:
Foot infections are a common and serious problem in persons with diabetes Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations) This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy) Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation) Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures Employing multidisciplinary foot teams improves outcomes Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIsread more
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Standards of Medical Care in Diabetes—2013
TL;DR: The recommendations included are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes that have been shown to be costeffective.
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Diabetic Foot Ulcers and Their Recurrence
TL;DR: This review considers the pathogenesis, treatment, and management of diabetic foot ulcers, including prevention of recurrence, in patients with diabetes mellitus.
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2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Marie Gerhard-Herman,Heather L. Gornik,Coletta Barrett,Neal R. Barshes,Matthew A. Corriere,Douglas E. Drachman,Lee A. Fleisher,Francis Gerry R. Fowkes,Naomi M. Hamburg,Scott Kinlay,Robert A. Lookstein,Sanjay Misra,Leila Mureebe,Jeffrey W. Olin,Rajan A.G. Patel,Judith G. Regensteiner,Andres Schanzer,Mehdi H. Shishehbor,Kerry J. Stewart,Diane Treat-Jacobson,M. Eileen Walsh +20 more
TL;DR: Jonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD; Sana M. Al-Khatib; and Lesley H. Curtis, PhD,FAHA are the current members of the FACC/FAHA Board of Directors.
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The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)
Joseph L. Mills,Michael S. Conte,David G. Armstrong,Frank B. Pomposelli,Andres Schanzer,Anton N. Sidawy,George Andros +6 more
TL;DR: The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.
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Global vascular guidelines on the management of chronic limb-threatening ischemia
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TL;DR: The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP) resulting in three stages of complexity for intervention.
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