Diabetic Infection

Infections In Patients With Diabetes Mellitus: A Review Of Pathogenesis

Go to: Diabetes mellitus (DM) is a clinical syndrome associated with deficiency of insulin secretion or action. It is considered one of the largest emerging threats to health in the 21st century. It is estimated that there will be 380 million persons with DM in 2025.[1] Besides the classical complications of the disease, DM has been associated with reduced response of T cells, neutrophil function, and disorders of humoral immunity.[2–4] Consequently, DM increases the susceptibility to infections, both the most common ones as well as those that almost always affect only people with DM (e.g. rhinocerebral mucormycosis).[4] Such infections, in addition to the repercussions associated with its infectivity, may trigger DM complications such as hypoglycemia and ketoacidosis. This article aims to critically review the current knowledge on the mechanisms associated with the greater susceptibility of DM for developing infectious diseases and to describe the main infectious diseases associated with this metabolic disorder. Continue reading >>

Avoiding Infections With Diabetic Foot Ulcers

Avoiding Uncontrollable Infections When Caring for Diabetic Foot Ulcers April 19, 2016by Advanced Tissue 02 Caring for diabetic foot ulcers improperly can lead to increased risk for complications like infections. Preventing and caring for diabetic foot ulcers is a top priority for anyone with diabetes. Approximately 15-25% of diabetics will develop a foot ulcer in their lifetime. If left untreated, diabetic foot ulcers can quickly become infected , require advanced wound care treatment, and may lead to amputation or an increased risk of serious health problems. Without the right preventative care plan, diabetic foot ulcers can cost a few thousand dollars to treat for the early stages to over $100,000 for infection care and amputation. Fortunately, this can all be prevented by caring for diabetic foot ulcers before they become infected and costly. As it is with most medical conditions, prevention is usually the best medicine. Washing your feet daily with soapy water and applying a moisturizing lotion are essential steps in optimal foot health. Keeping your skin strong and healthy can help protect against injury and resist cracking and blisters that can lead to diabetic foot ulcers. Properly fitted shoes and padded socks should always be worn to prevent rubbing and blisters. Toenails must also be cleaned and trimmed regularly to avoid dirt buildup. For anyone with diabetes, it is important to stay vigilant when caring for your lower extremities. Diabetics are prone to developing peripheral arterial disease, which causes poor circulation throughout your toes and feet. As a result, a loss of feeling in the feet makes is difficult for you to know when you have an injury or ulcer. This is why a daily visual inspection is a must for preventing uncontrollable foot infections. Continue reading >>

Surgical Treatment Of The Infected Diabetic Foot

Surgical Treatment of the Infected Diabetic Foot Diabetic Foot Unit, Department of Surgery, Twenteborg Hospital Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S123S128, Jeff G. van Baal; Surgical Treatment of the Infected Diabetic Foot, Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S123S128, Foot infections are common in the diabetic patient. Early recognition, proper assessment, and prompt intervention are vital. A combination of surgery and antibiotics is mandatory in virtually all foot infections. The aim of surgery is 2-fold: first, to control the infection, and second, to attempt to salvage the leg. The eventual goal is always to preserve a functional limb. Foot deformities resulting from surgery may cause reulceration and a high morbidity. The surgical treatment of the infection largely consists of draining of pus and removal of all necrotic and infected tissue. Frequently, revascularization of the foot is needed to save the limb; thus, there must be a close cooperation with the vascular surgical service. The surgeon must have a thorough knowledge of foot anatomy and must be familiar with the defects in wound healing that are caused by diabetes. The outcome of surgery mainly depends on the skill, care, and experience of the surgeon. The best results are achieved within a multidisciplinary setting. Most deep infections are preceded by tissue breakdown, with local penetration of bacterial pathogens to the deeper tissues. In many cases, the extent of the infection is underestimated; in 10%15% of mild infections and in 50% of serious infections, an underlying contiguous osteitis can be demonstrated [ 1 ]. Familiarity with the several causative factors that lead to foot complications in diabetic pa Continue reading >>

Diabetes And Infections

For people with diabetes, high blood sugars increase the risk of infections starting and spreading more quickly. High blood sugars also slow down the healing process and make infections more resistant to treatment. The first line of defense when it comes to managing the risk for infections is to manage your blood sugar levels as close to your target range as possible because high blood sugar can slow or limit your body’s ability to fight off infection. Some of the more likely places for infections in people with diabetes include the bladder, vagina, feet, kidneys, skin and gums. The Indian Journal of Endocrinology and Metabolism published a study by scientists who explain that the greater frequency of infections in people with diabetes is caused by numerous factors such as: high blood sugar levels that weaken the immune system micro- and macro-angiopathies (blood vessel disease) neuropathy which masks pain signals of an injury decrease in antibacterial activity of urine gastrointestinal and urinary function impairment frequent medical interventions due to other health issues People with diabetes are much more likely than people without diabetes to have a bladder infection which is also known as a urinary tract infection (UTI). UTI infections may involve the ureters, urethra, kidneys or bladder and you may experience pain, tiredness, nausea and fever. If you have a UTI, it is crucial to treat the infection because if not, the bacteria may spread to your kidneys and cause a dangerous kidney infection. An American Diabetes Association (ADA) published article states that more than 50% of men and women with diabetes live with some type of bladder dysfunction which involves symptoms like “urinary urgency, frequency, nocturia, and incontinence.” Early detection and treat Continue reading >>

10 Effective Remedies For Diabetic Foot Infections

flexitrinol.com/offici... Visit Site Diabetic foot infections can be dangerous and deadly for those who suffer from them, but there are a number of home remedies, including the use of American ginseng, astragalus, honey, Aloe vera, rhubarb root, psyllium, caffeine, and many more. What is Diabetic Foot Infections? Diabetic foot infections are painful and problematic conditions that affect thousands of diabetic patients every year, and is the leading cause behind nontraumatic lower extremity amputations. When the tissues or skin of the extremities become infected in diabetic patients, the results can be serious, due to the nature of the diabetic condition. Microvascular circulation in people with diabetes is impaired, which means that it is difficult or even impossible, in some cases, for phagocytic and other immune system compounds to reach and combat the foreign pathogen. An ulcer can form, and if the infection is not treated properly, it can stimulate the systemic inflammatory response syndrome. At this point, the body is no longer taking care of the infected region of the extremity, and amputation is often the only solution. Diabetic foot infections can be deadly, particularly if they are not addressed quickly and effectively. Formal treatments for diabetic foot infections include the use of antibiotics and localized approaches, but again, the success of these formal treatments is not always guaranteed, since the delivery system is essentially compromised. Many people have turned to more natural remedies and treatment strategies, which have less side effects than pharmaceuticals and have proven to be quite successful. Remedies for Diabetic Foot Infections Natural remedies contain combination of antioxidants, vitamins and organic compounds that help stimulate healing a Continue reading >>

Understanding Diabetic Foot Infection And Its Management - Sciencedirect

Volume 11, Issue 2 , AprilJune 2017, Pages 149-156 Understanding Diabetic Foot Infection and its Management Author links open overlay panel SabaNoora Get rights and content Diabetic Foot Ulcers (DFUs), a dreadful micro-vascular complication is liable for substantial increase in morbidity and mortality. DFU is a complicated amalgam of neuropathy, peripheral arterial diseases, foot deformities and infection. Spanning the spectrum from superficial cellulitis, microbial flora leads to chronic ostemyelitis and gangrenous extremity lower limb amputations. Wounds without affirmation of soft tissue or bone infection do not require antibiotic therapy. Treatment of mild and moderate infection requires empiric therapy covering gram-positive cocci, whereas severe or infection caused by drug resistant organisms needs broad spectrum anti-microbial targeting aggressive gram-negative aerobes and obligate anaerobes. Definitive therapy employed should be based on culture reports and clinical response. Evaluation of bone infection requires imaging by plain radiographs or MRI to increase sensitivity and specificity. Surgical interventions are must and may range from minor debridement to resections or revascularization and major amputations depending upon wound severity. On time and forceful management of diabetic foot ulcers by employing multidisciplinary management approaches focusing on prevention, learning, regular foot assessment, aggressive intervention, and optimal use of therapeutic footwear can often prevent exacerbation of the difficulty and eliminate the potential for amputation. Here, we review recent studies addressing diabetic foot infections with emphasis on pathophysiology, exclusive risk factors; evaluation including physical inspection, laboratory investigations, relevant Continue reading >>

Diabetic Foot Infections Can Be Reduced With Proper Treatment

Diabetics often suffer from foot infections, yet appropriate care can save limbs, and ultimately lives, according to the Infectious Diseases Society of America's new guidelines. The mortality rate for diabetics due to poor treatments of infected foot wounds that can subsequently lead to lower extremity amputation is worse than for the majority of cancers, given that around 50% of diabetics with foot amputations die within five years. The IDSA diabetic foot infection guidelines published in the journal Clinical Infectious Diseases have now revealed that about half of these lower extremity amputations can in fact be prevented through proper care of foot infections. Diabetics generally suffer from poor blood circulation, which means their sense of touch or pain sensitivity can be greatly compromised. For instance, a simple sore caused by a rubbing shoe or a cut can easily go unnoticed and become worse. One in four diabetics will have a foot ulcer, i.e. an open sore in their lifetime, which can easily become infected. If left untreated, these infections can spread and kill soft tissue and bone, which means that the dead and infected tissue needs to be surgically removed, and in severe cases, this means amputation of the toe, foot, or even part of the leg. Almost 80% of all non-traumatic amputations are performed in people with diabetes, and 85% of these amputations start with an open foot sore. Leading author, Benjamin A. Lipsky, MD, chair of the review panel, guidelines and professor of medicine at Washington University and VA Puget Sound in Seattle declared: "Lower extremity amputation takes a terrible toll on the diabetic patient. People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depre Continue reading >>

Idsa : Diabetic Foot Infections

*Every 12 to 18 months followingpublication, IDSA reviews its guidelines to determine whether an update isrequired.This guideline waspublished in June of 2012 and is the most current version. I. In which diabetic patients with a foot wound should I suspect infection, and how should I classify it? Clinicians should consider the possibility of infection occurring in any foot wound in a patient with diabetes (strong, low). Evidence of infection generally includes classic signs of inflammation (redness, warmth, swelling, tenderness, or pain) or purulent secretions, but may also include additional or secondary signs (eg, nonpurulent secretions, friable or discolored granulation tissue, undermining of wound edges, foul odor) (strong, low). Clinicians should be aware of factors that increase the risk for DFI and especially consider infection when these factors are present; these include a wound for which the probe-to-bone (PTB) test is positive; an ulceration present for >30 days; a history of recurrent foot ulcers; a traumatic foot wound; the presence of peripheral vascular disease in the affected limb; a previous lower extremity amputation; loss of protective sensation; the presence of renal insufficiency; or a history of walking barefoot (strong, low). Clinicians should select and routinely use a validated classification system, such as that developed by the International Working Group on the Diabetic Foot (IWGDF) (abbreviated with the acronym PEDIS) or IDSA (see below), to classify infections and to help define the mix of types and severity of their cases and their outcomes (strong, high). The DFI Wound Score may provide additional quantitative discrimination for research purposes (weak, low). Other validated diabetic foot classification schemes have limited value for inf Continue reading >>

Diabetes Mellitus And Infection

Some types of infection occur more frequently in patients with diabetes. This increased risk is largely attributable to an altered immune response due to chronic hyperglycaemia, but increased susceptibility to infection may also result from diabetic complications such as diabetic neuropathy and vascular insufficiency. Risk of most common infections is only modestly increased (e.g. 1.2 fold), but a number of rare but potentially fatal infections occur primarily or even almost exclusively in patients with diabetes. These include mucormycosis, emphysematous urinary tract infections, emphysematous cholecystitis, necrotizing fasciitis and malignant otitis externa. Immediate antimicrobial and/or surgical treatment is needed to prevent serious complications from these infections, including death. In general, antimicrobial treatment of infections in patients with diabetes is not different than in patients without diabetes. Glucose lowering therapy often needs to be increased to counter the loss of control associated with infection. Vaccinations against influenza and pneumococcal infections are recommended for patients with diabetes. Incidence and contributing factors People with diabetes are reported to experience 21% more infections than the general population[1]. Several factors may contribute to this, for example possible ‘reporting bias’: more frequent medical visits due to diabetes may lead to better recording of infectious complications. Even so, it seems clear that the risk of many common infections increases in proportion to hyperglycemia. Special problems may also arise in relations to diabetic nephropathy, which may undermine host defences against infection, and peripheral vascular disease which may impair tissue nutrition, oxygen supply and the ability to mount a Continue reading >>

Diabetic Foot Infections: Current Concept Review

Diabetic foot infections: current concept review The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high morbidity and risk factors for failure of treatment and classification systems are also described. Most diabetic foot infections begin with a wound and once an infection occurs, the risk of hospitalization and amputation increases dramatically. Early identification of infection and prompt treatment may optimize the patient's outcome and provide limb salvage. Keywords: diabetic foot infection , ulcer , guidelines , surgery More than 25 million people in the United States are estimated to have diabetes mellitus (DM), and 1525% will develop a diabetic foot ulceration (DFU) during their lifetime 1 Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293: 21728. 10.3402/dfa.v3i0.18409. [Taylor & Francis Online] , [Web of Science ] , [Google Scholar] 2 National diabetes fact sheet., 2011. US Department of Health and Human Services. Atlanta GA: Center for Disease Control and Prevention.2011. [Google Scholar] . Over 50% of these ulcerations will become infected, resulting in high rates of hospitalization, increased morbidity and potential lower extremity amputation. Diabetic foot infections (DFI) are one of the most common diabetes related cause o Continue reading >>

Concordance In Diabetic Foot Ulcer Infection

Abstract Introduction Accurate identification of pathogens, rather than colonising bacteria, is a prerequisite for targeted antibiotic therapy to ensure optimal patient outcome in wounds, such as diabetic foot ulcers. Wound swabs are the easiest and most commonly used sampling technique but most published guidelines recommend instead removal of a tissue sample from the wound bed, which is a more complex process. The aim of this study was to assess the concordance between culture results from wound swabs and tissue samples in patients with suspected diabetic foot infection. Methods and analysis Patients with a diabetic foot ulcer that is thought to be infected are being recruited from 25 sites across England in a cross-sectional study. The coprimary endpoints for the study are agreement between the two sampling techniques for three microbiological parameters: reported presence of likely isolates identified by the UK Health Protection Agency; resistance of isolates to usual antibiotic agents; and, the number of isolates reported per specimen. Secondary endpoints include appropriateness of the empiric antibiotic therapy prescribed and adverse events. Enrolling 400 patients will provide 80% power to detect a difference of 3% in the reported presence of an organism, assuming organism prevalence of 10%, discordance of 5% and a two-sided test at the 5% level of significance. Assumed overall prevalence is based on relatively uncommon organisms such as Pseudomonas. We will define acceptable agreement as κ>0.6. Ethics and dissemination Concordance in diabetic foot ulcer infection (CODIFI) will produce robust data to evaluate the two most commonly used sampling techniques employed for patients with a diabetic foot infection. This will help determine whether or not it is important Continue reading >>

What Infections Are You At Risk For With Diabetes?

People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection. What Kinds of Infections Are Most Likely If You Have Diabetes? When you have diabetes, you are especially prone to foot infections, yeast infections, urinary tract infections, and surgical site infections. In addition, yeast cells (Candida albicans) are more likely to colonize the mucous membranes (e.g., mouth, vagina, nose) in people with diabetes. These Candida cells then interfere with the normal infection-fighting action of white blood cells. With white blood cells impaired, Candida can replicate unchecked, causing yeast infections. High blood sugar levels contribute to this process. Other Sources of Diabetes-Related Infection Diabetic neuropathy (nerve damage) causes problems with sensation, particularly in the feet. This lack of sensation sometimes means foot injuries go unnoticed. Untreated injuries can lead to infection. Some types of neuropathy can also lead to dry, cracked skin, which allows a convenient entry point for infection into the body. People with diabetes often have low blood flow to the extremities. With less blood flow, the body is less able to mobilize normal immune defenses and nutrients that promote the body's ability to fight infection and promote healing. Why Are Infections Risky for People With Diabetes? People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defenses in diabetes. Studies have shown that even those who have minimally elevated blood sugar le Continue reading >>

Diabetes And Infection: How To Spot The Signs

Diabetes can slow down your body's ability to fight infection. The high sugar levels in your blood and tissues allow bacteria to grow and help infections develop more quickly. Common sites for these problems are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment can prevent more serious issues later on. What to Look For Most infections in people with diabetes can be treated. But you have to be able to spot the symptoms. Tell your doctor immediately if you have any of the following: Fever over 101 F Pain, tenderness, redness, or swelling Wound or cut that won't heal Red, warm, or draining sore Sore throat, scratchy throat, or pain when you swallow Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones White patches in your mouth or on your tongue Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy" Painful or frequent peeing or a constant urge to go Bloody, cloudy, or foul-smelling pee *CGM-based treatment requires fingersticks for calibration, if patient is taking acetaminophen, or if symptoms/expectations do not match CGM readings, and if not performed, may result in hypoglycemia. Please see important risk and safety information. Continue reading >>

Foot Wounds And Infections

Tweet Foot wounds must not be ignored by those of us with diabetes as there are very serious consequences if foot wounds do not heal properly. A wound which does not heal properly and is left exposed may form a foot ulcer which further raises the risk of an infection occurring. Indeed, if a wound becomes infected, amputation is a very real prospect if medical attention is not received quickly, as a result of severe complications like gangrene. Gangrene Gangrene is a serious medical condition that comes in two type, known as "wet" and "dry" gangrene. They are caused by bacterial infections or pre-existing health-issues respectively. Unfortunately, diabetics are at risk of both types. Gangrene is caused by a lack of blood flow to a certain part of the body, and so diabetes can cause "dry" gangrene by destroying blood vessels. Diabetics can also be at risk of the infections that destroy blood vessels or block off blood flow due to swelling because they have a weakened immune system. See here for more information on gangrene, what to do and how to prevent it. Signs of foot wounds Foot wounds are any break in the skin and therefore include any of the following that causes skin to be lost or open out: Cuts Grazes Blisters Cracked skin Loss of skin following a corn or callus In grown toenails pressing against the surrounding skin If you notice any signs of wounding, or any of the above signs that can lead to wounds, make an appointment to see your GP. If a wound has gone unnoticed or heals slowly, the affected area may grow larger and become a foot ulcer. Having a foot ulcer increases the risk of infection so it’s important to notify your GP or podiatrist as soon as possible. Symptoms of infection The following symptoms at the site of the wound may indicate that the foot has Continue reading >>

Diabetic Foot Infections

Practice Essentials Compromise of the blood supply from microvascular disease, often in association with lack of sensation because of neuropathy, predisposes persons with diabetes mellitus to foot infections. These infections span the spectrum from simple, superficial cellulitis to chronic osteomyelitis. The radiograph below demonstrates a foot lesion in a patient with diabetes. Signs and symptoms Diabetic foot infections typically take one of the following forms: Cellulitis Tender, erythematous, nonraised skin lesions are present, sometimes with lymphangitis Lymphangitis suggests group A streptococcal infection Bullae are typical of Staphylococcus aureus infection, but occasionally occur with group A streptococci · No ulcer or wound exudate is present Deep-skin and soft-tissue infections The patient may be acutely ill, with painful induration of the soft tissues in the extremity Wound discharge is usually not present In mixed infections that may involve anaerobes, crepitation may be noted over the afflicted area Extreme pain and tenderness may indicate compartment syndrome or clostridial infection (ie, gas gangrene) The tissues are not tense, and bullae may be present Discharge, if present, is often foul Acute osteomyelitis Unless peripheral neuropathy is present, the patient has pain at the site of the involved bone Usually, fever and regional adenopathy are absent Chronic osteomyelitis The patient's temperature is usually less than 102°F Discharge is commonly foul No lymphangitis is observed Pain may or may not be present, depending on the degree of peripheral neuropathy Deep, penetrating ulcers and deep sinus tracts (diagnostic of chronic osteomyelitis) are usually located between the toes or on the plantar surface of the foot The medial malleoli, shins, or heels Continue reading >>