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Diabetic Wound Infection

Diabetic Foot Infections Can Be Reduced With Proper Treatment

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 >>

6 Key Factors In Treating A Diabetic Wound

6 Key Factors In Treating A Diabetic Wound

Diabetic wound treatment methods require high attention to achieve healing. By 2030, it is estimated that more than 550 million people around the world will have diabetes. Approximately 25% of these diabetic patients will develop foot ulcers during their lifetime, which often require advanced diabetic wound treatment to prevent complications. To help achieve the optimal healing environment and protect against problems, there are six key factors to consider when treating diabetic wounds. 1. Wound Assessment Diabetic wounds fall into three categories: neuropathic, ischemic, and neuroischemic. Knowing the distinct features of each wound category is essential to identifying wound progression, infection, and healing. Failure to properly identify the type of wound that exists can lead to an ineffective diabetic wound treatment plan, causing long-term complications or amputation. 2. Tissue Debridement Wound debridement, or the removal of necrotic tissue from a wound, will reduce pressure, stimulate wound healing, allow for the inspection of underlying tissue, help with secretion or wound drainage, and optimize a wound dressing’s effectiveness. Clinicians typically recommend sharp debridement by scalpel or scissors, but there are other tissue-removal treatments they may recommend, including larval, autolytic, and ultrasonic. Only an experienced practitioner who knows which section of the tissue to remove without damaging blood vessels, nerves, or tendons should perform a debridement procedure. Understanding the importance of debridement to your diabetic wound treatment plan is often essential with advanced diabetic wounds. 3. Infection Control Infections are the top concern in any diabetic wound treatment plan. Due to the high morbidity and mortality rates associated with dia Continue reading >>

What’s The Connection Between Diabetes And Wound Healing?

What’s The Connection Between Diabetes And Wound Healing?

Diabetes is a result of your body’s inability to produce or use insulin. Insulin is a hormone that allows your body to turn glucose, or sugar, into energy. If your body has difficulty metabolizing glucose, it can lead to high blood sugar levels. This can affect your body’s ability to heal wounds. In people with diabetes, wounds tend to heal more slowly and progress more quickly, so it’s important to know what to look out for. Although cuts, grazes, scratches, and blisters can occur anywhere on the body, the feet are one of the most common places of injury. A small wound on the foot can quickly develop into a foot ulcer. Foot ulcers can become serious if left untreated. Between 14 and 24 percent of people who have diabetes and develop an ulcer will end up having a lower limb amputation. For this reason, it’s crucial that you do regular self-checks and closely monitor any wounds closely. Catching wounds early is the only way to reduce your risk of complications. Keep reading to learn more about the healing process, ways to speed the healing process along, and how to improve your body’s healing powers long-term. When you have diabetes, a number of factors can affect your body’s ability to heal wounds. High blood sugar levels Your blood sugar level is the main factor in how quickly your wound will heal. When your blood sugar level is higher than normal, it: prevents nutrients and oxygen from energizing cells prevents your immune system from functioning efficiently increases inflammation in the body’s cells These effects slow down wound healing. Neuropathy Peripheral neuropathy can also result from having blood sugar levels that are consistently higher than normal. Over time, damage occurs to the nerves and vessels. This can cause the affected areas to lose sen Continue reading >>

Wound Dressings In Diabetic Foot Disease

Wound Dressings In Diabetic Foot Disease

Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Reprints or correspondence: Dr. K. G. Harding, Wound Healing Research Unit, Cardiff Medicentre, Heath Park, Cardiff, United Kingdom CF14 4UJ ( [email protected] ). Search for other works by this author on: Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S100S103, J. R. Hilton, D. T. Williams, B. Beuker, D. R. Miller, K. G. Harding; Wound Dressings in Diabetic Foot Disease, Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S100S103, Wound dressings represent a part of the management of diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide wound protection, and encourage healing. No single dressing fulfills all the requirements of a diabetic patient with an infected foot ulcer. Dressings research in this area is generally poor. However, each category of dressings has particular characteristics that aid selection. Nonadhesive dressings are simple, inexpensive, and well tolerated. Foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. Hydrogels facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing inidine and silver may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds. All dressings require frequ Continue reading >>

Diabetes And Wounds: Caring For Sores

Diabetes And Wounds: Caring For Sores

When you have diabetes, it's vital to treat foot injuries right away. Even minor wounds can turn into serious foot ulcers, which can cost you a foot -- or an entire leg -- if you don’t care for them quickly and thoroughly. These easy steps can prevent problems down the road. Common Causes What you put on your feet matters. "You can get a foot ulcer from something as simple as walking in new or tight-fitting shoes or getting a small pebble stuck in the shoe,” says Raul Guzman, MD, a vascular surgeon at the Joslin Diabetes Center in Boston. If you have diabetes, you may get a kind of nerve damage that stops the feeling in your feet. Doctors call this neuropathy. If you can’t feel your feet, you may not know you’re hurt, and a small cut or sore can turn into something bigger. Or you might have poor blood flow to your feet, which makes it hard for even minor cuts to heal. Your doctor can tell you whether you have nerve damage or blood-flow problems. Guzman says he can do a test that shows how blood moves through your body. If the results are normal, you can have standard wound-care treatments. “If the results of this blood-flow test are abnormal, that means you have poor circulation that needs to be repaired,” he says. Surgery can help. “We can use a balloon and stent,” Guzman says, “or we can do a bypass procedure, where we connect the artery above the blockage to one of the arteries in the calf or foot.” Wound Treatment Options If you do injure your foot, don't try to take care of it at home. Go to a wound-care center or your doctor, even for blisters, calluses, and scratches. “Put on some antibiotic ointment and see a wound center or your doctor, at the latest, the next day,” says Harold Brem, MD, chief of the wound healing and regenerative medici Continue reading >>

Diabetic Foot Infections

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 >>

Wound Dressings In Diabetic Foot Disease

Wound Dressings In Diabetic Foot Disease

Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Wound Healing Research Unit, Department of Surgery, University of Wales College of Medicine Reprints or correspondence: Dr. K. G. Harding, Wound Healing Research Unit, Cardiff Medicentre, Heath Park, Cardiff, United Kingdom CF14 4UJ ( [email protected] ). Search for other works by this author on: Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S100S103, J. R. Hilton, D. T. Williams, B. Beuker, D. R. Miller, K. G. Harding; Wound Dressings in Diabetic Foot Disease, Clinical Infectious Diseases, Volume 39, Issue Supplement_2, 1 August 2004, Pages S100S103, Wound dressings represent a part of the management of diabetic foot ulceration. Ideally, dressings should alleviate symptoms, provide wound protection, and encourage healing. No single dressing fulfills all the requirements of a diabetic patient with an infected foot ulcer. Dressings research in this area is generally poor. However, each category of dressings has particular characteristics that aid selection. Nonadhesive dressings are simple, inexpensive, and well tolerated. Foam and alginate dressings are highly absorbent and effective for heavily exuding wounds. Hydrogels facilitate autolysis and may be beneficial in managing ulcers containing necrotic tissue. Dressings containing inidine and silver may aid in managing wound infection. Occlusive dressings should be avoided for infected wounds. All dressings require frequ Continue reading >>

Diabetic Wound Care | Foot Health | Patients | Apma

Diabetic Wound Care | Foot Health | Patients | Apma

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication. Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14-24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable. Anyone who has diabetes can develop a foot ulcer.Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers.People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease.Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, footdeformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes.Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack ofability to feel painin the feet due to nerve damage caused by elevated blood glucose levels over time.The nerve damage often can occur without pain, and one may not even be aware of the problem.Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament. Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection.Elevations in blood glucose can reduce the body's ability to fig Continue reading >>

How To Care For Cuts And Scratches If You Have Diabetes

How To Care For Cuts And Scratches If You Have Diabetes

If you have diabetes , you may want to be a little more cautious about taking care of simple cuts, scratches, scrapes and bruises. In fact, skin care of any kind is important to your health. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy Bruises are the simplest to address. As long as the skin is not broken, you really dont need to do much of anything, except keep an eye on the area. A bruise is a bruise and will act like a bruise and go through the different changes in color over time, says dermatologist Christine Poblete-Lopez, MD . So being diabetic does not necessarily mean it will lengthen the way a bruise will resolve or not. If you have any type of laceration, however, you should keep a keen watch for infections because diabetics are more prone to developing infections, according to Dr. Poblete-Lopez. The signs of infection to look for around the cut are redness, warmth, tenderness and pus drainage. If you have any of those signs, you definitely need to bring it to the attention of your doctor, because you may need oral antibiotics, she says. There are some differences of opinion among diabetes experts and dermatologists when it comes to healing wounds, so we will take a look at both. When cleaning out a cut, for example, diabetes specialist Leann Olansky, MD, says to wash the cut with soap and waterandthen add an over-the-counter topical antibiotic such as Neosporin or a prescription ointment such as Bactroban to help prevent bacteria from entering into your subcutaneous tissue. The next step for Dr. Olansky is to cover the cut with a bandage to keep it moist so that it will heal faster. I dont think theres any advantage to keeping i Continue reading >>

Diabetic Foot Infections

Diabetic Foot Infections

Diabetic foot infection, defined as soft tissue or bone infection below the malleoli, is the most common complication of diabetes mellitus leading to hospitalization and the most frequent cause of nontraumatic lower extremity amputation. Diabetic foot infections are diagnosed clinically based on the presence of at least two classic findings of inflammation or purulence. Infections are classified as mild, moderate, or severe. Most diabetic foot infections are polymicrobial. The most common pathogens are aerobic gram-positive cocci, mainly Staphylococcus species. Osteomyelitis is a serious complication of diabetic foot infection that increases the likelihood of surgical intervention. Treatment is based on the extent and severity of the infection and comorbid conditions. Mild infections are treated with oral antibiotics, wound care, and pressure off-loading in the outpatient setting. Selected patients with moderate infections and all patients with severe infections should be hospitalized, given intravenous antibiotics, and evaluated for possible surgical intervention. Peripheral arterial disease is present in up to 40% of patients with diabetic foot infections, making evaluation of the vascular supply critical. All patients with diabetes should undergo a systematic foot examination at least once a year, and more frequently if risk factors for diabetic foot ulcers exist. Preventive measures include patient education on proper foot care, glycemic and blood pressure control, smoking cessation, use of prescription footwear, intensive care from a podiatrist, and evaluation for surgical interventions as indicated. Diabetic foot infections, which are infections of the soft tissue or bone below the malleoli, are a common clinical problem. Most infections occur in a site of skin tr Continue reading >>

Concordance In Diabetic Foot Ulcer Infection

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 >>

Tips For Diabetes Wound Care

Tips For Diabetes Wound Care

A small cut can turn into a large complication when diabetes enters the picture. For one thing, diabetes can lead to a weakened immune system "so a simple cut or scrape can get infected easier than in someone who doesn’t have diabetes,” said Kiersten Weber, DPM, a podiatrist with the University of Oklahoma's Harold Hamm Diabetes Center in Oklahoma City. Neuropathy or nerve damage, one of the many diabetes side effects, also can play a role. Neuropathy can occur because extra sugar in the bloodstream can damage your nerves over time. “It usually starts in the smallest blood vessels, which are in the hands and feet,” explains Dr. Weber, and when you have neuropathy, you have decreased feeling in your feet. As a result, you may not feel pain if you have a cut or blister on your foot, and if you don’t know it’s there and don’t treat it, the sore could become infected. That’s why regularly inspecting your feet for cuts, scrapes, blisters, calluses, and other wounds is such an important part of diabetes care, she said. “If you can’t lift your feet, have someone do it for you and look at the bottom of your feet,” Weber said. “You also can use mirrors to inspect the bottom of your feet if you need.” Preventing Cuts and Scrapes Of course, the best way to protect yourself is to make a serious effort to prevent wounds. Make sure you never walk barefoot, even inside your home, and always wear good-fitting shoes. “I also tell my patients to check the inside of their shoes for stones,” Weber said. “If you have neuropathy, you could get a small stone in your shoe and not know it.” Protect your feet by letting your podiatrist handle even minor foot issues. Don’t try to remove calluses or warts yourself.You might be tempted to try commercial preparati Continue reading >>

Diabetes And Its Effect On Wound Healing And Patient Care

Diabetes And Its Effect On Wound Healing And Patient Care

VOL: 99, ISSUE: 42, PAGE NO: 70 Maria Mousley, MSc, BSc, DpodM, is chief podiatrist in diabetes care, Northampton Primary Care Trust Diabetes is a multisystem disorder that affects the wound healing process. Full, instant access to all stories Customised email alerts straight to your inbox 5,000+ practice articles in our clinical archive Online learning units on fundamental aspects of nursing care Speak with a member of the team about providing Nursing Times for your whole team Already have an account? Sign in Continue reading >>

Diabetic Wounds

Diabetic Wounds

Diabetes mellitus can be virtually harmless if controlled, but the state of abnormally high blood glucose levels associated with the condition can lead to some serious complications. If left uncontrolled for a long time, or if diabetic patients fail to adapt their lifestyles in order to manage the disease, they will have more difficulty preventing complications from occurring. A serious complication that diabetics may encounter are diabetic wounds. Causes of Diabetic Wounds The main concern with diabetic wounds is poor or delayed healing. Healing problems are caused by the peripheral arterial diseases and peripheral neuropathy that can occur with diabetes, wherein the small blood vessels in different parts of the body, especially in the extremities (hands and feet), grow narrower and reduce the blood circulation to those areas. A lack of circulation in the extremities can result in a reduced supply of oxygen and nutrients to the body tissue and nerves, which is necessary for healing. Over time, nerves in these areas may become damaged, decreasing the sensation of pain, temperature and touch, making patients vulnerable to injury. Types of Diabetic Wounds For a diabetic patient, every wound is a health concern and requires immediate attention. The most common two types are wounds of external origin and wounds of internal origin. Due to peripheral neuropathy, wounds of external origin, such as skin cuts, burns, bumps and bruises, may often go unnoticed by the diabetic patient. If external wounds go unnoticed for some time, delayed treatment can put the patient at risk for further complications. Wounds of internal origin, such as skin ulcers, ingrown toenails or calluses, can lead to the breakdown of skin and surrounding tissue, increasing the risk of bacterial infections. Continue reading >>

Delay In Treatment Diabetic Wound Infection Death - Medical Malpractice Settlement

Delay In Treatment Diabetic Wound Infection Death - Medical Malpractice Settlement

Delay in treatment of diabetic wound brings $900,000 settlement Death from infection from delay in treatment of diabetics wound ulcer The plaintiffs decedent was a 70-year-old diabetic woman who died from sepsis on 11/01/02. The plaintiff claimed that the sepsis was the result of the defendants failure to recognize, diagnose and treat an evolving and worsening right heel ulcer that the defendant did not competently manage over a period of several weeks. The defendant began treating the plaintiffs decedent in October of 2001. On 4/19/02, she was seen by the defendant for complaints of a right heel ulcer that had been present for 1-2 weeks. The defendant diagnosed her with a cellulitis and prescribed Keflex 500mg, 3 times a day for 10 days, warm soaks, and bacitracin to her ulcer. On 5/23/02, she followed up with the defendant for complaints of frequent nosebleeds. The medical record for this visit contains the notation right heel ulcer also, but the defendant did not note anything about examining the heel or following up on treatment. Approximately three weeks later, on 6/17/02, the plaintiffs decedent again sought treatment from the defendant for complaints of right heel redness, swelling, and burning. The defendant noted that her heel had a 4x4cm area of blackened eschar (dead tissue). He prescribed Santyl ointment and saline dressings. Three days later, on 6/20/02, she was again seen by the defendant who noted that her heel was unchanged. The plaintiffs decedent followed up on 7/1/02 with the defendant who noted that her heel ulcer persisted at the same size and that black eschar was present. He also noted that he would continue to treat her with the Santyl ointment and saline dressings. On 7/11/02, the defendant found that the ulcer has increased to a 6 x 7 cm black Continue reading >>

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