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Current Concepts in Clinical Based Management of Diabetic Foot Infections:A Review


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1 Department of Pharmacology, Columbia Institute of Pharmacy, Tekari, Near Vidhansabha, Raipur -493111Dist- Raipur (C.G.), India
     

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Diabetic foot ulcers (DFUs) are potentially mortifying complications in need of multidisciplinary endeavour. Imbalance of harmony in glucose homeostasis causes hyperglycemic status which in turn leads to activation of certain metabolic pathways subsequently that lead to development of vascular insufficiency, nerve damages headed by ulceration in lower extremity due to plantar pressures and foot deformity. The standard of care for DFUs consists of several conventional treatments such as, daily wound care dressings, off loading, infection control, glucose control and adequate Perfusion etc. Still the reported healing rate varied between 20.0% and 46.2%.So some newly invented therapies such as negative pressure therapy, topical therapies, hyperbaric oxygen therapy, growth factors, and other antibiotic therapies took upper hand over the conventionally used medications for the treatment of diabetic foot infections. These new therapies also bring about new opportunities for DFU patients. In this review our efforts have been devoted to summarize the various treatments available along with possible mechanism of action for the effective treatment of diabetic foot ulcers.

Keywords

Diabetic Foot Infections, Diagnosis, Becaplermin, PDGF, Antibiotic Therapy.
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  • 1.Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, et al. (2011) National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2•7 million participants. Lancet 378: 3140.

  • International Diabetes Federation (2012) The Global Burden. IDF Diabetes Atlas Fifth Edition.

  • Malik VS, Popkin BM, Bray GA, Després JP, Hu FB (2010) Sugar sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121: 1356-1364.

  • DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977-986.

  • National Institute for Health and Clinical Excellence. Diabetic foot problems: inpatient management of diabetic foot problems. Clinical guideline 119. London: NICE, 2011. Accessed March 2013, Abetz L, Sutton M, Brady L, et al. The diabetic foot ulcer scale: a quality of life instrument for use in clinical trials. Pract Diab Int 2002; 19: 167-75.

  • Schaper NC, Van Netten JJ, Apelqvist J, et al. Prevention and Management of Foot Problems in Diabetes: A Summary Guidance for Daily Practice Based on the 2015 IWGDF Guidance Documents. Diab Metab Res Rev. DOI:10.1002/dmrr.2695.

  • Jane Kelly, M.D. Director, National Diabetes Education Program CDC National Center for Chronic Disease Prevention and Health Promotion page no 1

  • Harikumar K, Kumar Bk, Hemalatha Gj, Kumar Mb, Lado Sf. A Review On Diabetes Mellitus. International Journal Of Novel Trends In Pharmaceutical Sciences

  • Rabbani N, Alam SS, Riaz S, Larkin JR, Akhtar MW, Shafi T, Thornalley PJ. High-dose thiamine therapy for patients with type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study. Diabetologia. 2009 Feb 1;52(2):208-12.

  • Pendey SP (2010) Understanding diabetic foot. Int J Diabetes Dev Ctries 30:75-79.

  • Jeffcoate WJ, Harding KG (2003) Diabetic foot ulcers. Lancet 361: 1545-1551.

  • Aguilar F, ”Diabetic Neuropathy” for doctors, Plast and Rest Neural, 4, 1-2, (2005), pp 35-47. ISSN 1665-3254 2005, Boulton AJM, 2003.

  • Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990; 13: 513– 521.

  • Uc¸ kay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-oftheart update. J Hosp Infect 2012; 84: 5–12.

  • 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.

  • Pataky Z, Vischer U. Diabetic foot disease in the elderly. Diabetes Metab 2007; 33: 56–65.

  • 17.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.

  • 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.

  • Apelqvist J, Castenfors J, Larsson J. Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabet Med 1989; 6:526-530.

  • Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am. J. Surg. 1998; 176(Suppl. 2A):5S–10S.

  • Apelqvist J, Castenfors J, Larsson J. Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabet Med 1989; 6:526-530.

  • Oyibo SO, Jude EB, Tarawneh I, et al. The effect of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med 2001; 18(2):133-138.

  • Margolis DJ, Kantor J, Santanna J, et al. Risk factors for delayed healing of neuropathic diabetic foot ulcers: A pooled analysis. Arch Dermatol 2000; 136(12):1531-1535.

  • Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: The association of wound size, wound duration, and wound grade on wound healing. Diabetes Care 2002; 25(10): 835-1839.

  • Pecoraro RE, Ahroni J, Boyko EJ, et al. Chronology and determinants of tissue repair in diabetic lower extremity ulcers. Diabetes 1991; 40: 1305-1313.

  • McNeely MJ, Bokyo EJ. Diabetes related comorbitidies in Asian Americans: Results of a National Health Survey. J Diabetes Complications 2005; 19(2):101-106.

  • Oyibo SO, Jude EB, Tarawneh I, et al. The effect of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med 2001; 18(2):133-138.

  • Margolis DJ, Kantor J, Santanna J, et al. Risk factors for delayed healing of neuropathic diabetic foot ulcers: A pooled analysis. Arch Dermatol 2000; 136(12):1531-1535.

  • Margolis DJ, Kantor J, Santanna J, et al. Risk factors for delayed healing of neuropathic diabetic foot ulcers: A pooled analysis. Arch Dermatol 2000; 136(12):1531-1535.

  • Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: The association of wound size, wound duration, and wound grade on wound healing. Diabetes Care 2002; 25(10): 835-1839.

  • Pecoraro RE, Ahroni J, Boyko EJ, et al. Chronology and determinants of tissue repair in diabetic lower extremity ulcers. Diabetes 1991; 40: 1305-1313.

  • Sheehan P, Jones P, Caselli A, et al. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care 2003; 26(6):1879-1882.

  • McNeely MJ, Bokyo EJ. Diabetes related comorbitidies in Asian Americans: Results of a National Health Survey. J Diabetes Complications 2005; 19(2):101-106.

  • Abbott CA, Vileikyte L, Williamson S, et al. Multicentre study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabete Care 2004; 94(5):379–83.

  • Kumar S, Ashe HA, Parnell LN, et al. The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet. Med. 1994; 11: 480–484.

  • Walters DP, Gatling W, Mullee MA, et al. The distribution and severity of diabetic foot disease: A community study with comparison to a non-diabetic group. Diabet Med 1992; 9:354-358.

  • Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW (1995) Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA 273: 721-723.

  • Boulton AJ, Kirsner RS, Vileikyte L (2004) Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 351: 48-55.

  • Mayfield JA, Sugarman JR (2000) The use of the Semmes-Weinstein monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. J Fam Pract 49: S17-29.

  • Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW (1994) Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854-860.

  • Rogers LC, Bevilacqua NJ (2008) The diagnosis of Charcot foot. Clin Podiatr Med Surg 25: 43-51,

  • Unger J, Cole BE (2007), Recognition and management of diabetic neuropathy. Prim Care 34: 887-913.

  • Illigens BM, Gibbons CH (2009) Sweat testing to evaluate autonomic function.Clin Auton Res 19: 79-87.

  • Koenig RJ, Peterson CM, Jones RL, Saudek C, Lehrman M, et al. (1976) Correlation of Glucose Regulation and Hemoglobin AIc in Diabetes Mellitus. N Engl J Med 295: 417-420.

  • Rabjohn L, Roberts K, Troiano M, Schoenhaus H (2007) Diagnostic and prognostic value of erythrocyte sedimentation rate in contiguous osteomyelitis of the foot and ankle. J Foot Ankle Surg 46: 230-237.

  • Boulton AJ, Kirsner RS, Vileikyte L (2004) Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 351: 48-55.

  • Tiktin M, Celik S and Berard L. Understanding adherence to medications in type 2 diabetes care and clinical trials to overcome barriers: a narrative review. CurrMed Res Opin 2016; 32: 277– 287.

  • Tesfaye S, Boulton AJM and Dickenson A. Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. Diabetes Care 2013; 36: 2456–2465.

  • Hsu CR, Chang CC, Chen YT, Lin WN and Chen MY. Organization of wound healing services: the impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement. Division of Plastic Surgery, Chang Gung memorial hospital, Taiwan. Diabetes Res ClinPract 2015; 109: 77–84.

  • Armstrong DG, Lavery LA, Wu S and Boulton AJ. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 2005; 28: 551–554.

  • Hilton JR, Williams DT, Beuker B, Miller DR and Harding KG. Wound dressings in diabetic foot disease. Clin Infect Dis 2004; 39: S100–S103.

  • Dumville JC, Deschpande S, O’Meara S and Speak K. Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database Syst Rev Issue 2012; 2: CD009099.

  • Jude EB, Apelqvist J, Spraul M and Martini J. Silver dressing study group. Prospective randomized controlled study of hydrofiber dressing containing ionic silver or calcium alginate dressing in nonischaemic diabetic foot ulcers. Diabet Med 2007; 24: 280–288.

  • Health Quality Ontario. Negative Pressure Wound Therapy: an evidence-based analysis. Ont Health Technol Assess 2006; 6: 1– 38.

  • Greenhalgh DG. The role of growth factors in wound healing. J Traum Inj Infc Clin Care 1966; 41: 159–87.

  • Singer AL, Clark RAF. Cutaneous wound healing. N Engl J Med 1999; 341: 738–46.

  • Bennett NT, Schultz GS. Growth factors and wound healing: Part II. Role in normal and chronic wound healing. Am J Surg 1993; 166: 74–81.

  • Mast BA, Schultz GS. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Rep Reg 1996; 4: 411–20.

  • Diegelmann RF, Evans MC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci 2004; 9: 283–89.

  • Bowler PG. Wound pathophysiology, infection and therapeutic options. Ann Med 2002; 34: 419–27.

  • Goldman R. Growth factors and chronic wound healing: past, present and future. Adv Skin Wound Care 2004; 17: 24–35.

  • Robson MC. Cytokine manipulation of the wound. Clin Plast Surg 2003; 30: 57–65.

  • Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg 1998; 176(2A suppl):26S-38S.

  • Hart CE, Bailey M, Curtis DA, et al. Purification of PDGF-AB and PDGF-BB from human platelet extracts and identification of all PDGF dimmers in human platelets. Biochemistry 1990;29: 166–77.

  • Nagai MK, Embil JM. Becaplermin: recombinant platelet derived growth factor, a new treatment for healing diabetic foot ulcers. Expert Opin Biol Ther 2002; 2: 211–8.

  • Meyer-Ingold W. Wound therapy: growth factors as agents to promote healing. Trends Biotechnol 1993; 11: 387–92.

  • Hart CE, Forstrom JW, Kelly JD, et al. Two classes of PDGF receptor recognize different isoforms of PDGF. Science 1988; 240: 1529–31.

  • Pierce GF, Mustoe TA, Altrock BW, Deuel TF, Thomason A. Role of platelet-derived growth factor in wound healing. J Cell Biochem 1991; 45: 319–26.

  • 69. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A (2003) Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes care 26: 1879-1882.

  • http://www.iodine.com/drug/regranex/fda-package-insert.

  • Nedeljković-Beleslin B, Beleslin D. Becaplermin: A new effective and safe adjuvant topical therapy in patients with chronic neuropathic diabetic foot ulcer. Medicus. 2005;6(3):25-9.

  • Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA (2000) Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol 136: 1531-1535.

  • Boyko EJ, Lipsky BA. Infection and diabetes mellitus. In Harris MI (ed): Diabetes in America, 2nd edition. NIH publication No 95-1468. Bethesda, MD: National Institute of Health. 1995, pp 485-499.

  • Muller LM, Gorter KJ, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005; 41(3): 281-288.

  • Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot?. Diabetes Metab. Res. Rev 2000;16:S75–S83.

  • Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, Sumithra S. Bacteriology of diabetic foot lesions. Indian Journal of Medical Microbiology 2004; 22(3): 175-178.

  • Tice A, Hoaglund P, Giani G, et al. Outcomrs of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med 2003; 114(9): 723-728.

  • Lipsky BA, McDonald D, Litka PA. Treatment of infected diabetic foot ulcers: Topical MSI-78 vs. oral ofloxacin (abstract) Diabetologia 1997; 40(1): 482.

  • Raymakers JT, Houben AJ, et al. The effect of diabetes and severe ischaemia on the penetration of ceftazidime into tissues of the limb. Diabetic Medicine 2001; 18(3): 229-234.

  • Armstrong DG, Stephan KT, Joseph, et al. What is the shelf life of physician- mixed antibiotic-impregnated calcium sulphate pellets? J Foot Ankle Surg 2003, 42(5): 302-304.

  • Van Damme H, Rorive M, Lavery LA, et al. Amputations in diabetic patients: A plea for footsparing surgery. Acta chir Belg 2001; 101(3): 123-129.

  • Rauwerda JA. Surgical treatment of the infected diabetic foot. Diabetes Metab Rs Rev2004, 20(1): S41-S44.

  • Tan JS, Friedman NM, Hazelton-Miller C, et al. Can aggressive treatment of diabetic foot infection reduce the need for above-ankle amputation? Clin Infect Dis 1996; 23: 286-291.


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  • Current Concepts in Clinical Based Management of Diabetic Foot Infections:A Review

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Authors

Jhakeshwar Prasad
Department of Pharmacology, Columbia Institute of Pharmacy, Tekari, Near Vidhansabha, Raipur -493111Dist- Raipur (C.G.), India
Ashish Kumar Netam
Department of Pharmacology, Columbia Institute of Pharmacy, Tekari, Near Vidhansabha, Raipur -493111Dist- Raipur (C.G.), India
Mahendra Kumar Sahu
Department of Pharmacology, Columbia Institute of Pharmacy, Tekari, Near Vidhansabha, Raipur -493111Dist- Raipur (C.G.), India
Trilochan Satapathy
Department of Pharmacology, Columbia Institute of Pharmacy, Tekari, Near Vidhansabha, Raipur -493111Dist- Raipur (C.G.), India

Abstract


Diabetic foot ulcers (DFUs) are potentially mortifying complications in need of multidisciplinary endeavour. Imbalance of harmony in glucose homeostasis causes hyperglycemic status which in turn leads to activation of certain metabolic pathways subsequently that lead to development of vascular insufficiency, nerve damages headed by ulceration in lower extremity due to plantar pressures and foot deformity. The standard of care for DFUs consists of several conventional treatments such as, daily wound care dressings, off loading, infection control, glucose control and adequate Perfusion etc. Still the reported healing rate varied between 20.0% and 46.2%.So some newly invented therapies such as negative pressure therapy, topical therapies, hyperbaric oxygen therapy, growth factors, and other antibiotic therapies took upper hand over the conventionally used medications for the treatment of diabetic foot infections. These new therapies also bring about new opportunities for DFU patients. In this review our efforts have been devoted to summarize the various treatments available along with possible mechanism of action for the effective treatment of diabetic foot ulcers.

Keywords


Diabetic Foot Infections, Diagnosis, Becaplermin, PDGF, Antibiotic Therapy.

References