Diabetic foot infections: State-of-the-art

Diabetes, Obesity and Metabolism

Volumn 16, Issue 4, 2014, Pages 305-316

  Uckay I ^a   Gariani, K ^a   Pataky, Z ^a   Lipsky, B A ^a,b  

^a GENEVA UNIVERSITY HOSPITALS   (Switzerland)

^b UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

Diabetes complications; Diabetes mellitus; Foot complications; Infections

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT;

AMPUTATION; ANTIBIOTIC THERAPY; ANTIMICROBIAL THERAPY; ANTISEPSIS; CLASSIFICATION; CLINICAL PATHWAY; DIABETES MELLITUS; DIABETIC FOOT; DIABETIC PATIENT; DISEASE CLASSIFICATION; EVIDENCE BASED PRACTICE; FOOT ULCER; GAIT DISORDER; HUMAN; HYPERBARIC OXYGEN; INFECTION RISK; LEG AMPUTATION; MICROBIOLOGY; MORBIDITY; MOTOR NEUROPATHY; NONHUMAN; ORTHOPEDIC SURGERY; OSTEOMYELITIS; PATHOPHYSIOLOGY; PERIPHERAL ISCHEMIA; PERIPHERAL NEUROPATHY; PODIATRY; PRACTICE GUIDELINE; QUALITY OF LIFE; REVASCULARIZATION; REVIEW; SENSORY NEUROPATHY; TOPICAL TREATMENT; VACUUM ASSISTED CLOSURE; WOUND CARE; WOUND DRESSING; COMPLICATION; DEBRIDEMENT; ECONOMICS; FEMALE; MALE; MULTIMODALITY CANCER THERAPY; RISK FACTOR; SECONDARY PREVENTION; STATISTICS AND NUMERICAL DATA; TREATMENT OUTCOME; WOUND HEALING; WOUND INFECTION;

AMPUTATION; ANTI-BACTERIAL AGENTS; COMBINED MODALITY THERAPY; DEBRIDEMENT; DIABETIC FOOT; FEMALE; HUMANS; MALE; NEGATIVE-PRESSURE WOUND THERAPY; OSTEOMYELITIS; PRACTICE GUIDELINES AS TOPIC; QUALITY OF LIFE; RISK FACTORS; SECONDARY PREVENTION; TREATMENT OUTCOME; WOUND HEALING; WOUND INFECTION;

EID: 84895083124     PISSN: 14628902     EISSN: 14631326     Source Type: Journal    
DOI: 10.1111/dom.12190     Document Type: Review

References (138)

1. Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990; 13: 513-521.
2. Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 2012; 84: 5-12.
3. Pataky Z, Assal JP, Conne P, Vuagnat H, Golay A. Plantar pressure distribution in type 2 diabetic patients without peripheral neuropathy and peripheral vascular disease. Diabet Med 2005; 22: 762-767.
4. Pataky Z, Vischer U. Diabetic foot disease in the elderly. Diabetes Metab 2007; 33: 56-65.
5. Peeters P, Verbist J, Keirse K, Callaert J, Deloose K, Bosiers M. Endovascular procedures and new insights in diabetic limb salvage. J Cardiovasc Surg (Torino) 2012; 53: 31-37.
6. Pataky Z, Golay A, Bounameaux H, Bobbioni-Harsch E, Assal JP. Relationship between peripheral vascular disease and high plantar pressures in diabetic neuro-ischaemic patients. Diabetes Metab 2003; 29: 489-495.
7. Darbellay P, Uçkay I, Dominguez D et al. Diabetic foot infection: a multidisciplinary approach. Rev Med Suisse 2011; 7: 894-897.
8. Prompers L, Schaper N, Apelqvist J et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. Diabetologia 2008; 51: 747-755.
9. Tennvall GR, Apelqvist J, Eneroth M. Costs of deep foot infections in patients with diabetes mellitus. Pharmacoeconomics 2000; 18: 225-238.
10. Dunkel N, Belaieff W, Assal M et al. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. J Orthop Sci 2012; 17: 588-594.
11. Mutluoǧlu M, Sivrioǧlu AK, Eroǧlu M et al. The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds. Scand J Infect Dis 2013; 45: 497-503.
12. Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Influence of osteomyelitis location in the foot of diabetic patients with transtibial amputation. Foot Ankle Int 2013; 34: 222-227.
13. Lipsky BA, Berendt AR, Cornia PB et al. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54: 132-173.
14. Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006; 29: 1288-1293.
15. Peters EJ, Lavery LA, Armstrong DG. Diabetic lower extremity infection: influence of physical, psychological, and social factors. J Diabetes Complications 2005; 19: 107-112.
16. Dubsky M, Jirkovska A, Bem R et al. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis of a Eurodiale subgroup. Int Wound J 2013; 10: 555-561.
17. Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev 2004; 20: 90-95.
18. Lee HS, Choi YR, Ha SH, Jeong JJ. Pyoderma gangrenosum mimicking a diabetic foot infection: a case report. J Foot Ankle Surg 2013; 52: 67-71.
19. Uçkay I, Garzoni C, Ferry T et al. Postoperative serum pro-calcitonin and C-reactive protein levels in patients with orthopedic infections. Swiss Med Wkly 2010; 140: 13124.
20. Senneville E, Melliez H, Beltrand E et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 2006; 42: 57-62.
21. Bernard L, Assal M, Garzoni C, Uçkay I. Predicting the pathogen of diabetic toe osteomyelitis by two consecutive ulcer cultures with bone contact. Eur J Clin Microbiol Infect Dis 2011; 30: 279-281.
22. Newman LG, Waller J, Palestro CJ et al. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline. JAMA 1991; 266: 1246-1251.
23. Lavery LA, Peters EJ, Armstrong DG, Wendel CS, Murdoch DP, Lipsky BA. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Res Clin Pract 2009; 83: 347-352.
24. Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 2008; 299: 806-813.
25. Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients? Diabet Med 2011; 28: 191-194.
26. Lipsky BA, Peters EJ, Senneville E et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev 2012; 28: 163-178.
27. Senneville E, Morant H, Descamps D et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis 2009; 48: 888-893.
28. Aslangul E, M'Bemba J, Caillat-Vigneron N et al. Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture. Diabetes Care 2013; 36: 2203-2210.
29. Alvaro-Afonso FJ, Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E, Cecilia-Matilla A, Beneit-Montesinos JV. Interobserver and intraobserver reproducibility of plain X-rays in the diagnosis of diabetic foot osteomyelitis. Int J Low Extrem Wounds 2013; 12: 12-15.
30. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis 2008; 47: 519-527.
31. Kapoor A, Page S, Lavalley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med 2007; 167: 125-132.
32. Vartanians VM, Karchmer AW, Giurini JM, Rosenthal DI. Is there a role for imaging in the management of patients with diabetic foot? Skeletal Radiol 2009; 38: 633-636.
33. Senneville E, Gaworowska D, Topolinski H et al. Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot. Diabet Med 2012; 29: 56-61.
34. Gardner SE, Hillis SL, Heilmann K, Segre JA, Grice EA. The neuropathic diabetic foot ulcer microbiome is associated with clinical factors. Diabetes 2013; 62: 923-930.
35. Ramakant P, Verma AK, Misra R et al. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia 2011; 54: 58-64.
36. Aamir AH, Nasir A, Jadoon MZ, Mehmood K, Ali SS. Diabetic foot infections and their management in a tertiary care hospital. J Ayub Med Coll Abbottabad 2011; 23: 58-62.
37. Dowd SE, Wolcott RD, Sun Y, McKeehan T, Smith E, Rhoads D. Polymicrobial nature of chronic diabetic foot ulcer biofilm infections determined using bacterial tag encoded FLX amplicon pyrosequencing. PLoS One 2008; 3: 3326.
38. Pai SA, Vijaykumar H, Sreevathsa MR, Parag D. Comparative study of community and hospital acquired infections in diabetic foot. Int J Microbiol 2012; 10: 1-4.
39. Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL. Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation. Int J Low Extrem Wounds 2013; 12: 63-68.
40. Di Benedetto C, Lew D, Uçkay I. Post-traumatic septic arthritis. Eur Musculoskelet Rev 2012; 7: 38-42.
41. Bader M, Jafri AK, Krueger T, Kumar V. Fusarium osteomyelitis of the foot in a patient with diabetes mellitus. Scand J Infect Dis 2003; 35: 895-896.
42. Boyanova L, Mitov I. Antibiotic resistance rates in causative agents of infections in diabetic patients: rising concerns. Expert Rev Anti Infect Ther 2013; 11: 411-420.
43. Ozer B, Kalaci A, Semerci E, Duran N, Davul S, Yanat AN. Infections and aerobic bacterial pathogens in diabetic foot. Afr J Microbiol Res 2010; 4: 2153-2160.
44. Missoni EM, Kalenic S, Vukelic M et al. Role of yeasts in diabetic foot ulcer infection. Acta Med Croatica 2006; 60: 43-50.
45. Djahmi N, Messad N, Nedjai S et al. Molecular epidemiology of Staphylococcus aureus strains isolated from inpatients with infected diabetic foot ulcers in an Algerian University Hospital. Clin Microbiol Infect 2013; 19: E398-404.
46. Byren I, Peters EJ, Hoey C, Berendt A, Lipsky BA. Pharmacotherapy of diabetic foot osteomyelitis. Expert Opin Pharmacother 2009; 10: 3033-3047.
47. Widatalla AH, Mahadi SE, Shawer MA, Mahmoud SM, Abdelmageed AE, Ahmed ME. Diabetic foot infections with osteomyelitis: efficacy of combined surgical and medical treatment. Diabet Foot Ankle 2012; 3: 18809-18815.
48. Pataky Z, Golay A, Faravel L et al. The impact of callosities on the magnitude and duration of plantar pressure in patients with diabetes mellitus. A callus may cause 18, 600 kilograms of excess plantar pressure per day. Diabetes Metab 2002; 28: 356-361.
49. Tian M, Jiang YZ, Niu YW, Xiao YR, Lu SL, Wang XQ. A severely infected diabetic foot treated successfully without using systemic antibiotics. Int J Low Extrem Wounds 2012; 11: 296-298.
50. Assal M, Ray A, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique. J Bone Joint Surg Am 2010; 92: 20-31.
51. Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int 2012; 33: 1069-1074.
52. Kearney TP, Hunt NA, Lavery LA. Safety and effectiveness of flexor tenotomies to heal toe ulcers in persons with diabetes. Diabetes Res Clin Pract 2010; 89: 224-226.
53. van Netten JJ, Bril A, van Baal JG. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe. J Foot Ankle Res 2013; 6: 3.
54. Schaper NC, Andros G, Apelqvist J et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2012; 28: 218-224.
55. Soderstrom M, Alback A, Biancari F, Lappalainen K, Lepantalo M, Venermo M. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers. J Vasc Surg 2013; 57: 427-435.
56. Alexandrescu V, Hubermont G. Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist? Diabetes Metab Syndr Obes 2011; 4: 327-336.
57. Lipsky BA. Empirical therapy for diabetic foot infections: are there clinical clues to guide antibiotic selection? Clin Microbiol Infect 2007; 13: 351-353.
58. Reber A, Moldovan A, Dunkel N et al. Should the methicillin-resistant Staphylococcus aureus carriage status be used as a guide to treatment for skin and soft tissue infections? J Infect 2012; 64: 513-519.
59. Uçkay I, Pittet D, Vaudaux P, Sax H, Lew D, Waldvogel F. Foreign body infections due to Staphylococcus epidermidis. Ann Med 2009; 41: 109-119.
60. Richard JL, Sotto A, Jourdan N et al. Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers. Diabetes Metab 2008; 34: 363-369.
61. Uçkay I, Teterycz D, Ferry T et al. Poor utility of MRSA screening to predict staphylococcal species in orthopaedic implant infections. J Hosp Infect 2009; 73: 89-91.
62. Uçkay I, Jugun K, Gamulin A, Wagener J, Hoffmeyer P, Lew D. Chronic osteomyelitis. Curr Infect Dis Rep 2012; 14: 566-575.
63. Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE, Abramson MA. Ertapenem versus piperacillin/tazobactam for diabetic foot infections: prospective, randomised, controlled, double-blinded, multicentre trial. Lancet 2005; 366: 1695-1703.
64. Lipsky BA, Stoutenburgh U. Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections. J Antimicrob Chemother 2005; 55: 240-245.
65. Schaper NC, Dryden M, Kujath P et al. Efficacy and safety of IV/PO moxifloxacin and IV piperacillin/tazobactam followed by PO amoxicillin/clavulanic acid in the treatment of diabetic foot infections: results of the RELIEF study. Infection 2013; 41: 175-186.
66. Nelson EA, O'Meara S, Golder S, Dalton J, Craig D, Iglesias C. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med 2006; 23: 348-359.
67. Crouzet J, Lavigne JP, Richard JL, Sotto A. Diabetic foot infection: a critical review of recent randomized clinical trials on antibiotic therapy. Int J Infect Dis 2011; 15: 601-610.
68. Peters EJ, Lipsky BA, Berendt AR et al. A systematic review of the effectiveness of interventions in the management of infection in the diabetic foot. Diabetes Metab Res Rev 2012; 28: 142-162.
69. Embil JM, Rose G, Trepman E et al. Oral antimicrobial therapy for diabetic foot osteomyelitis. Foot Ankle Int 2006; 27: 771-779.
70. Spellberg B, Lipsky BA. Systemic antibiotic therapy for chronic osteomyelitis in adults. Clin Infect Dis 2012; 54: 393-407.
71. Dang CN, Prasad YD, Boulton AJ, Jude EB. Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003; 20: 159-161.
72. Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006; 29: 1727-1732.
73. Kashef N, Esmaeeli Djavid G, Siroosy M, Taghi Khani A, Hesami Zokai F, Fateh M. Photodynamic inactivation of drug-resistant bacteria isolated from diabetic foot ulcers. Iran J Microbiol 2011; 3: 36-41.
74. Lipsky BA, Holroyd KJ, Zasloff M. Topical versus systemic antimicrobial therapy for treating mildly infected diabetic foot ulcers: a randomized, controlled, double-blinded, multicenter trial of pexiganan cream. Clin Infect Dis 2008; 47: 1537-1545.
75. Chhibber S, Kaur T, Sandeep K. Co-therapy using lytic bacteriophage and linezolid: effective treatment in eliminating methicillin resistant Staphylococcus aureus (MRSA) from diabetic foot infections. PloS One 2013; 8: e56022.
76. Schaper NC, Dryden M, Kujath P et al. Efficacy and safety of IV/PO moxifloxacin and IV piperacillin/tazobactam followed by PO amoxicillin/clavulanic acid in the treatment of diabetic foot infections: results of the RELIEF study. Infection 2013; 41: 175-86.
77. Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero Y, Sanz-Corbalán I, Hernández-Herrero MJ, Cabrera-Galván JJ. Super-oxidized solution (dermacyn wound care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: preliminary experience in a specialized department. Int J Low Extrem Wounds 2013; 12: 130-7.
78. Ramsey SD, Newton K, Blough D et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 1999; 22: 382-387.
79. Lazzarini L, Lipsky BA, Mader JT. Antibiotic treatment of osteomyelitis: what have we learned from 30years of clinical trials? Int J Infect Dis 2005; 9: 127-138.
80. Liu R, Li L, Yang M, Boden G, Yang G. Systematic review of the effectiveness of hyperbaric oxygenation therapy in the management of chronic diabetic foot ulcers. Mayo Clin Proc 2013; 88: 166-175.
81. Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg Br 2001; 83: 403-407.
82. Pittet D, Wyssa B, Herter-Clavel C, Kursteiner K, Vaucher J, Lew PD. Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up. Arch Intern Med 1999; 159: 851-856.
83. Jeffcoate WJ, Lipsky BA. Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis 2004; 39: 115-122.
84. Berendt AR. Counterpoint: hyperbaric oxygen for diabetic foot wounds is not effective. Clin Infect Dis 2006; 43: 193-198.
85. Margolis DJ, Gupta J, Hoffstad O et al. Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and the prevention of amputation: a cohort study. Diabetes Care 2013; 36: 1961-1966.
86. Londahl M. Hyperbaric oxygen therapy as adjunctive treatment for diabetic foot ulcers. Int J Low Extrem Wounds 2013; 12: 152-157.
87. Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev 2012; 4: CD004123.
88. Londahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care 2010; 33: 998-1003.
89. Mulder G, Tallis AJ, Marshall VT et al. Treatment of nonhealing diabetic foot ulcers with a platelet-derived growth factor gene-activated matrix (GAM501): results of a phase 1/2 trial. Wound Repair Regen 2009; 17: 772-779.
90. Buchberger B, Follmann M, Freyer D, Huppertz H, Ehm A, Wasem J. The evidence for the use of growth factors and active skin substitutes for the treatment of non-infected diabetic foot ulcers (DFU): a health technology assessment (HTA). Exp Clin Endocrinol Diabetes 2011; 119: 472-479.
91. Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis 2009; 49: 1541-1549.
92. Hinchliffe RJ, Andros G, Apelqvist J et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev 2012; 28: 179-217.
93. Dumville JC, Deshpande S, O'Meara S, Speak K. Foam dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev 2013; 6: CD009111.
94. Jeffcoate WJ, Price PE, Phillips CJ et al. Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes. Health Technol Assess 2009; 13: 1-86.
95. Dumville JC, Deshpande S, O'Meara S, Speak K. Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev 2012; 2: CD009099.
96. Dumville JC, O'Meara S, Deshpande S, Speak K. Alginate dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev 2012; 2: CD009110.
97. Lipsky BA, Kuss M, Edmonds M, Reyzelman A, Sigal F. Topical application of a gentamicin-collagen sponge combined with systemic antibiotic therapy for the treatment of diabetic foot infections of moderate severity: a randomized, controlled, multicenter clinical trial. J Am Podiatr Med Assoc 2012; 102: 223-232.
98. Berendt AR, Peters EJ, Bakker K et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev 2008; 24: 145-161.
99. Yarwood-Ross L, Dignon AM. NPWT and moist wound dressings in the treatment of the diabetic foot. Br J Nurs 2012; 21: 30-32.
100. Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 2008; 31: 631-636.
101. Noble-Bell G, Forbes A. A systematic review of the effectiveness of negative pressure wound therapy in the management of diabetes foot ulcers. Int Wound J 2008; 5: 233-242.
102. Malacarne S, Paoli C, Philippe J. Important of off loading in the treatment of foot diabetic ulcers. Rev Med Suisse 2011; 7: 1267-1268.
103. Pataky Z, Faravel L, Da Silva J, Assal J. A new ambulatory foot pressure device for patients with sensory impairment. A system for continuous measurement of plantar pressure and a feed-back alarm. J Biomechanics 2000; 33: 1135-1138.
104. Centre for Clinical Practice. Diabetic foot problems: Inpatient management of diabetic foot problems (CG 119). London: NICE, 2011, 31 pp. Available from URL: http://publications.nice.org.uk/diabetic-foot-problems-cg119. Accessed 20 August 2013.
105. Alvarsson A, Sandgren B, Wendel C, Alvarsson M, Brismar K. A retrospective analysis of amputation rates in diabetic patients: can lower extremity amputations be further prevented? Cardiovasc Diabetol 2012; 11: 18.
106. Cornia PB, Amory JK, Fraser S, Saint S, Lipsky BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003; 114: 404-407.
107. Whippy A, Skeath M, Crawford B et al. Kaiser Permanente's performance improvement system, part 3: multisite improvements in care for patients with sepsis. Jt Comm J Qual Saf 2011; 37: 483-493.
108. Haynes K, Linkin DR, Fishman NO et al. Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. J Am Med Inform Assoc 2011; 18: 164-168.
109. Carvalho CB, Neto RM, Aragao LP, Oliveira MM, Nogueira MB, Forti AC. Diabetic foot infection. Bacteriologic analysis of 141 patients. Arq Bras Endocrinol Metabol 2004; 48: 398-405.
110. Candel Gonzalez FJ, Alramadan M, Matesanz M et al. Infections in diabetic foot ulcers. Eur J Intern Med 2003; 14: 341-343.
111. Anandi C, Alaguraja D, Natarajan V et al. Bacteriology of diabetic foot lesions. Ind J Med Mircobiol 2004; 22: 175-178.
112. Unachukwu CN, Obunge OK, Odia OJ. The bacteriology of diabetic foot ulcers in Port Harcourt, Nigeria. Niger J Med 2005; 14: 173-176.
113. Senneville E. Antimicrobial interventions for the management of diabetic foot infections. Expert Opin Pharmacother 2005; 6: 263-273.
114. Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complications 2005; 19: 138-141.
115. Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med 2005; 16: 567-570.
116. Yoga R, Khairul A, Sunita K, Suresh C. Bacteriology of diabetic foot lesions. Med J Malaysia 2006; 61: 14-16.
117. Sharma VK, Khadka PB, Joshi A, Sharma R. Common pathogens isolated in diabetic foot infection in Bir Hospital. Kathmandu Univ Med J 2006; 4: 295-301.
118. Örmen B, Türker N, Vardar I et al. Clinical and bacteriological analysis of diabetic foot infections. İnfek Derg (Turk J Infect) 2007; 21: 65-69.
119. Raja NS. Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol Immunol Infect 2007; 40: 39-44.
120. Çetin M, Ocak S, Kuvandik G, Aslan B. Comparison of bacterial isolates cultured from hemodialysis patients and other patients with diabetic foot and their antimicrobial resistance. Ren Fail 2007; 29: 973-978.
121. Dowd SE, Delton Hanson J, Rees E et al. Survey of fungi and yeast in polymicrobial infections in chronic wounds. J Wound Care 2011; 20: 40-47.
122. Umadevi S, Kumar S, Joseph NM et al. Microbiological study of diabetic foot infections. Ind J Med Spec 2011; 2: 12-17.
123. Khoharo KH, Ansari S, Qureshi F. Diabetic foot ulcers; common isolated pathogens & in vitro antimicrobial activity. Professional Med J 2009; 16: 53-60.
124. Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot (Edinb) 2011; 21: 6-14.
125. Mendes JJ, Marques-Costa A, Vilela C et al. Clinical and bacteriological survey of diabetic foot infections in Lisbon. Diabetes Res Clin Pract 2012; 95: 153-161.
126. Hayat SA, Khan AH, Masood N, Shaikh N. Study for microbiological pattern and in vitro antibiotic susceptibility in patients having diabetic foot infections at tertiary care hospital in Abbottabad. World Appl Sci J 2011; 12: 123-131.
127. Pappu AP, Sinha A, Johnson A. Microbiological profile of diabetic foot ulcer. Calicut Med J 2011; 9: 1-4.
128. Malone M, Bowling FL, Gannass A, Jude EB, Boulton AJ. Deep wound cultures and bone biopsy in diabetic foot osteomyelitis. Diabetes Metab Res Rev 2013; 29: 546-550.
129. Aziz Z, Lin WK, Nather A, Huak CY. Predictive factors for lower extremity amputations in diabetic foot infections. Diabet Foot Ankle 2011; 2: 7463-7469.
130. Tiwari S, Pratyush DD, Dwivedi A, Gupta SK, Rai M, Singh SK. Microbiological and clinical characteristics of diabetic foot infections in northern India. J Infect Dev Ctries 2012; 6: 329-332.
131. Swarna SRMR, Gomathi S, Thamaraiselvi D, Thamaraiselvi S. A study of biofilm in diabetic foot ulcer. Int J Res Pharma Biomed Sci 2012; 3: 1809-1814.
132. Parvez N, Dutta P, Ray P et al. Microbial profile and utility of soft tissue, pus, and bone cultures in diagnosing diabetic foot infections. Diabetes Technol Ther 2012; 14: 669-674.
133. Banashankari GSRH, Harsha AH. Prevalence of gram negative bacteria in diabetic foot-a clinico-microbiological study. Al Ameen J Med Sci 2012; 5: 224-232.
134. Al Benwan K, Al Mulla A, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health 2012; 5: 1-8.
135. Shanmugam P, Jeya M, Susan SL. The bacteriology of diabetic foot ulcers, with a special reference to multidrug resistant strains. J Clin Diagn Res 2013; 7: 441-445.
136. Anjali SSP, Ghosh SJ. Detection of multidrug resistant gram negative bacilli in type ii diabetic foot infections. Int J Med Health Sci 2013; 2: 186-194.
137. Osariemen IJ, Olowu SS, Adevbo E et al. Aerobic bacteria associated with diabetic wounds in patients attending clinic in a rural community in Nigeria. Glob Res J Microbiol 2013; 3: 8-11.
138. Dezfulian A, Salehian MT, Amini V et al. Bacteriological study of diabetic foot infections in an Iranian hospital. Iran Red Cres Med J 2011; 13: 590-591.