Diagnosis and treatment of diabetic foot infections

Executive summary

1. foot diseases in patients with diabetes, disease, and health care professionals to amputation of the extremity and low cause trips can be self-destructive.

2. diabetic foot by local (feet) into the blood stream and systemic (metabolic) issues and the associated management, preferably moltadaskaplanari fotcari team (A-II) attention is required by. These diseases should be added to the team to manage infectious diseases expert, or a medical or auto access, a microbioligist (B-II) is.

3. major pradaspasang iolsraon adjoining in these diseases, which is usually the element for foot neuropathy is related to. Peripheral vascular disease and various ammnalogakal ankle a secondary role. 4. kokaka arubak Gram-positive infections (especially aoreos area) are predominant pathogens in diabetic foot. That chronic wounds or who recently have received antibiotic therapy with مُبتلا, and negative rods also atents g with askhamia foot or gangrene can aoblagty anaerobic pathogens.

5. wound infection in clinical signs and symptoms of local (and sometimes sistemitic) must be assessed on the basis of inflammation. Except in cases of infection, laboratory investigations (including major) aostumilatas diagnasang are restricted for use (B-II) ۔

6. specamance infection, except perhaps that in all these cases, experimental light and treatment before antibiotic treatment to properly send obtained before starting culture (B-III). Baopse, ulcer surgery treatment method or wish to wound tissue obtained by specamance broom specamance are preferable (A-I).

7. diagnosis of soft-tissue imaging study or better deep, prolent can help define a set and usually need bone results in detection. Simple radevgrapei in many cases may be suitable, but MRI (preferred isotope scanning), more sensitive and specific, particularly for soft-tissue research.

8. clinical and laboratory features easily by infection assisabali (B II) should be based on the severity of their classification. Absorbed into the blood stream and systemic toxicity artral specific tissue involved, or the presence of metabolic instability of prfuon adequacy of these are most important. Category classification of patient and limb and, therefore, the risk for the management of the venue immediately and helps determine the status of.

9. the evidence available antibiotic therapy (D-III), as well as treating clinically ananfactid does not support had an ulcer.

Antibiotic therapy is required for practically all the infected wound, but it often is insufficient without proper wound care.

10. an experimental antibiotic regimen of potential infections and ataalogak no-cost (s) (B-II) on the basis of the severity of select. Arubak kokaka only purpose on Gram-positive therapy have recently been found in patients with antibiotic therapy (A-II)-moderate infections may be enough for. Brodspctorm experimental therapy need not be normal but severe infections with antibiotics pending results of the culture, and what is the point for Susceptibility data (B-III). There is no current antibiotic therapy and antibiotic susceptibility of local data, especially the spread of resistant s. aoreos boss (Mirza) or other resistant organisms. The results of both the culture and the capability of data and experimental definitive therapy regimen (C-III) should be based on clinical response.

11. only limited evidence, oral and parantral different topical antibiotics to make informed choices in agents. Some of the moderate and severe infections virtually all parantral therapy at least initially is required (C-III).

One of the most highly bwawalabla oral antibiotics in moderate light and many infections, including aostumilatas (A-II) can be used in some patients. Topical therapy can be used to light some superficial infection (B-I).

12. antibiotic therapy until the infection is resolved there is authority, although it is not compulsory until a wound is healed to continue. Antibiotic therapy for the duration of the suggestions are as follows: 1 – 2 weeks is usually sufficient for mild infection, but some require an additional 1-2 weeks: moderate and severe infection is usually 2-4 weeks for coffee, depending on the structures of dibrademant, involved, type of competence Soft-tissue injuries and wounds cover oascolarati (A II). And aostumilatas for at least 4-6 weeks is required, but one of the affected bone is removed to the duration, and may be affected if an extended period of time is required, then there is plenty Cord (B-II) is.

13. If a clinically stable patient infections 1 antibiotic courses failed to respond, consider all anmakrobalis dascontanwang and, after a few days to get a maximum of culture Specamance (C-III).

14. surgical & consultation is required when a deep abscess, bone or joint, broad intervention, kripatous, necrosis or gangrene accompanied by enough, or faskatas (A II) nicrotisang intervention for infection. Artral supply of limb and indicated when revascolarizang are of particular importance. With experience and interest in the field of foot surgeons care team if possible, should be recruited.

15. more and more wound care, appropriate antibiotic treatment is essential for healing infections as well as provide (A-I). Dibrademant kalllos and nicrotik tissue in the wound, a proper cleaning and pressure, particularly off-loading are included. Insufficient evidence to recommend the use of a custom wound dressing or any kind of wound healing agents or infected foot wounds is for products.

16. Select the medical and surgical treatment of patients with infected wounds have been rigamance to ensure proper initial and follow up need careful observation and effective (B-III).

17. education in diabetic feet properly for infection is not defined the role of the most adjunktowi treatment granlacati hiprbarak into the blood stream and systemic factors that encourage regular reviews suggest the colony can prevent oxygen therapy (B-I). Severe infections or treat them properly into the blood stream and systemic therapy in spite of not respond to local correct all amenable for them can be useful Negative factors.

18. bone (astiatas or aostumilatas) nonanfacshos astuarthropethe the spread of sexually transmitted infections can be difficult to distinguish from it. Examination and test Clinical Imaging desire, But for the formation of bone baopse aostumilatas diagnosis, organism (s), and thus to define the cell (B-II) of antibiotics to determine soscaptablates is worth a look.

19. Although this field has matured, more research is needed. The Committee especially recommends in detail and potential studies adequately powered, aostumilatas diagnasang, rigamance the best classification of infection antibiotics in various situations, and appreciate the role of surgery in the treatment of aostumilatas (A-3) began to be correct obvious system.

Introduction

Not only is the purpose of. A common, complex diseases with diabetes feet and costly problem is [1: 4]. In addition to the severe morbdates, now the largest number of days in hospital for diabetes-related beds – [5] [6, 7], most common accounts and proximate, are nontramtak. Diabetic foot infection, and careful attention to integrated management, preferably a moltadaskaplanari is required by foot care team (A-II) [8-13]. These diseases should be included, or preferably prepared team to manage access, a medical specialist or a microbioligist infectious diseases (B-III) is [1]. Diabetic foot infection-related best management by potentially morbdates events, and the need for, and the duration of that limb amputation [14, 15] can low. Unfortunately, These diseases are often inadequately lit situations management [16]. The current diagnostic and treatment approaches, insufficient resources dedicated to understanding this problem fasting, or as a result of a lack of cooperation, lack of effective moltadaskaplanari, may. The primary purpose of clinical depression, psychological pain for diabetic feet and to reduce the financial costs associated with infections is to help. For the General management of the diabetic foot and diabetic foot iolsraon [17-19] other published instructions for cover is the center of attention primarily to manage diabetic patient suspected or revealed Monday on the sexually transmitted infections. Primary care practice in some medical conditions and realities of the lack of resources to implement the recommendation of the members of the Committee some sense of the limited methods and treatment. We, however, in almost all settings, high quality care, usually no more difficult or poor care and to obtain the results [20, 21] compared to the expensive sure. Therefore, a framework must provide for the treatment of all diabetic patients suspected of a foot infection. While other resources increased, the staff will need some skills training and operations coordination of available health care centres will be able to implement it immediately. For use with (medical, financial and environmental) including antibiotics, wound care, along with prescrabang for inappropriate behaviour can reduce associated.

The diagnostic test, surgical procedure and treatment decisions, are adjunktowi. We hope that this wonderful Saint Vincent Declaration [22] lower amputation according to international rates will contribute to reduce. Be cost-saving compromise, even though it called for preventive foot care, add an identifier (especially MRI), testing can be offset by and for vascular intervention [12].

Method. The Committee's experience and diabetic foot infections, most of which with interest in the infectious diseases society of America guidelines in writing experience consists of members. Members of the Committee are from several American States, and other countries. Their backgrounds and medical research, clinical practice, infectious diseases, podiateri Academy, bench and represent the industry. Three of the members of the international diabetic foot antrnataonaloorkang to members of the group are also published.

Diagnasang on consensus and in 2003 [23] infection in diabetic feet treatment guidelines. (Which madlona corani aibisca, database, library database, diabetic feet and hands-bbleographes by searching Web sites and published subjects included bbleographes) in search of a vast literature, since the members of the Committee reviewed all the available evidence, and in a series of meetings to discuss and reach consensus over a period of three years and public debate through. Three sbekomates that were developed and modified sbsectance. This final document, which were based on reviews of both inner and outer went through many revisions served as a basis for. Due to the relative brevity of the rndomaid high-quality evidence in this box, or other control cases, most of our recommendations are for discussion and opinion (B-II) [24]. In this way, we offer a relatively short summary and those who would like to review the data to provide a wide bbleograpei selected.

Patovisaaloge of infection

A diabetic foot infection in a person with diabetes only most is declared as a anframallioler infection. Kelolatas, miosatas, nicrotisang, faskatas, paronichia, these are tindonatas and aostumilatas joint pain, are included. The most common and classic lisaaon, however, is diabetes is "mal prforance" affected Monday had an ulcer. This injury risk factors [25, 26], blend a mix of 2 results. Neuropathy sensory, motor, and iolsraon a central role with ankle trauma or due to excessive pressure on a distorted sense of security feet 18 m angry independent functions. Once the skin's protective layer, root tissues are exposed to bacterial colonization begun to break. This wound infection and infection deeper tissues by the connected extensions development activity you can do. This series of events can be very fast (on the day or even hours, especially in a limb aschimack) is. Different

Alimara, especially those who poorly feature ammnalogak paolmorfonocler leukocytes may affect some diabetic patients involved, and did not rule out the possibility of the risk of infection in the feet [27-30] is added to the intensity.

Microbiology

Arubak kokaka-quarters are in the skin and break makerorgansm Gram-positive plant embedded. S. aoreos and (b) himolitak striptcooka (groups A, C and G, but especially Group B) most commonly isolated pathogens [31-38] as well. Antrobacteroii, antrokoka, anarubas, chronic wounds, including the development of a more complex flora aoblagty psiodomonas airoganos, kalonizang, and sometimes other

Nonfrmantetavi gram negative rods [39-43]. At the same time, surgical procedures, and especially, long or broad-spectrum antibiotic therapy patients settlement and/or antibiotics resistant organisms (for example, Mirza oankomikan-resistant antrokoka or [and]), as well as infection can pradaspasi for [44]. Most of the patients are isolated from the top before Mirza strains although there are issues associated with community and now becoming a common [45] [46-48] infections in patients with diabetic feet is associated with worse results. Oankomikan (or glikopaptadi)-intermediate s. aoreos has been isolated in many countries. According to a diabetic patient's notes on the first day of a 2 foot infection [49] oankomikan-resistant s. aoreos is involved in the cases.

The soft tissue around the camp of disabled nicrotik oarolancy kalonasers korinibectriom quagolasanigtaoi staphelokoka and low defense or cord, species ("dafatrwads"), a role [43, 50] that will allow duty. While chronic paolmakrobial often [31, 36, 43, 51] anmakrobalis, who had recently been found in patients are infection often (almost always with an arubak gramposatowi Cocos), are monomakrabal. This way, the cultures of patients with mixed infection usually specamance have 3 – 5 isolates export, Gram-positive and Gram negative arubas and anarubas [14, 34, 37, 38, 40, 41, 52-58] are included. in a paolmakrobial infection often every single character is unclear.

The patient's wound and infection, critical reviews

Diabetic foot wounds, none of which patients with each other can become several types can develop. The presence of respiratory infections in medical prolent (content) or at least 2 inflammation (redness, warmth, swelling or stiffness, and pain or tenderness); primary foundations of the structure must be assessed (see Figure 1) all had an ulcer is infected (B-II) [23]. exclusion, but infection often had an ulcer healing is not, by definition. Diabetic foot infections include review and manage treatment [15, 23, 40] for the selection of the appropriate method for the option as a basis for determining the intensity of infection (B II). The problem of aostumilatas is particularly confusing and complex and thus separately with solution. (B-III): Overall, the affected limb or as infected sore feet and is patient. The purpose of this limit and clinical pathogenesis or infection, wound, a wound biology (and, in this way, the ability to heal), due to the contribution of the altered foot biomechanics, vascular (especially artral) having any assistance and to determine the presence of makrobial aitaologi.

Sistemitic results of any infection. Lack of skills or experience to any of your clanacans should seek appropriate advice.

The severity of infection to determine the test to determine the severity of the infection and the results of the overall management plan (see Figure 2) can be used for the format (B II). Unfortunately, the definition of injury and infection and the lack of consensus on a classification system comparison of published studies sent is a problem. Wagner [15, 40, 98, 99] system has been used for 25 years on a large scale, but "disoascoler" was designed for severe disease scud feet, and a single party [100-105] contains all the infections within. The main issues in order to arrive at a consensus that preparing.

Diabetic foot wounds are in classification (which tissues are involved in particular,) this depth and whether either injury or infection askhamia [23, 101, 106-108] by complex (b). The international consensus on the diabetic foot, recently had an ulcer diabetic foot an initial progress report classification system for research purposes [23] what is published. Tkhles prfuon, akeronam are the main elements of the padas (limit/

A reduction in size, depth/tissue, infection and sense). Infection in the category of grade 1 (no infection), 2 (skin and subcutaneous tissue involvement only), (kilolates or wide deep infection) 3 and 4 (one sistemitic the presence of inflammation response syndrome) are included. Because this system based on research which is designed to be applicable for all had an ulcer, it includes a variety of ananfactid lisens for grade 1. 2 – 4 grade are similar. Infected wounds (see Figure 2), the most important preliminary work for patients who need immediate parantral the same, and experimental broad-spectrum antibiotic therapy and diagnostic testing and quick thinking, surgical consultation is to recognize. We have designated as "intense." as a possible infection infection as "light" description from the Syrian medical ananfactid should be but lisens.

Otherwise, it is relatively easy to recognize. This term covers a broad spectrum of injuries as "moderate" infection, "he said, because the biggest difficulty, praise, some of which can be very complex and are also threatened limb. Other terms of "non-complex" and "classification schemes" is used for the light and moderate with complex sinonimosli, but we cordoned off a wound that confusion can want to avoid various complications. The difference between the more moderate and severe infection as less attached to the patient what to do with his feet. This difference is the fact that patients with infection  a complex by ambatritinang 50% sistemitic not signs or symptoms. After the talks, and at the many schemes for classification (B-II) as a basis for discussion, this is after.

Infection treatment

Ananfactid alsratance is prescrabang to avoid antibiotics. Some say that many seemingly had an ulcer is actually infected diabetic foot ananfactid sbclanakall  that is, they have a high level of "critical" in "baobordan" settlement, and the results of ampars [54, 109-114] wound healing (usually as per gram tissue cell 1105) bacteria are composed of. Available published evidence does not support the use of antibiotics for the management ananfactid for medical alsratance of either healing or [115, 116] as provilkss against infection is a wound. Anmakrobal use of antibiotics encourages resistance, and the negative effects of the financial cost of capital and may cause drug-related ananfactid is discouraged because we had an ulcer therapy. In some cases, it's a chronic wound drains, it turns out that it is difficult to decide whether, when a single pollutant or aschimack feet, such as granulation tissue, the odor, the aging coloration unexpected pain or tenderness, or with an otherwise when it is associated with properly cure had an ulcer healing progress [117, 118] failed to appear. I can tell a short course of antibiotic therapy is appropriate, culture (C-III) might be. This is the determination of the need for. This is an expensive part of the treatment of diabetic foot infections and the need for medical and social issues, co-ordinate. Or acute or critical limb askhamia patients with complex diseases by should be the top usually (C-III) [119, 120]. Some patients with seemingly light and moderate infection infection requires more patients with the same. This observation may be for an instant identifier, there may be factors in their testing, or wound care or antibiotic treatment is likely to affect the fellowship. These features can be created in the absence of light or moderate with most patients patient's infection (A-II) can be treated as [84, 121]. Stabilize the patient. In General, it is necessary to participate in the metabolic State of the patient [25, 122].

This can include the restoration of fluid balance and alectraolte. Hiprglcamia, hiprasmolalati, acadosas and asotemia correct. Treating disorders and other American leaders. Severely ill patients need surgery usually must be stable before the migration in the operating room, although surgery usually offer for 148 h (B-III) [123] must not be delayed after hospital. Glikimack infection in control improvements and the Elimination of [124] can help in wound healing. Infection may be easier to control, improving hiprglcamia. Choose an antibiotic regimen. Antibiotic regimen of choice in the decision about the route to therapy, to deal with specific medicine makerorgansm initially and later includes the precise selection treatment regimen and duration. Home treatment is usually experimental infection and severity of any existing large data available, such as the current culture results or findings should be based on "Samir Arts g. For more severe infections, chronic moderate for infection, it is safest to start therapy with broad-spectrum agents. This negative and anaerobic organisms, as well as aoblagty g (B-III) (including locations where it is common Mirza), should take action against gram-positive kokaka. To ensure proper and prompt in the tissue, the number should be given parantrall therapy, at least initially (C-III).

Although some infections [125-127] majority of mild to moderate infections, and many experimental treatments offer broad-spectrum  a relatively narrow spectrum only like arubak gramposatowi kokaka (A II) can be treated with agents with covering [84]. Although it is called anaerobic Due to several isolated severe infection [42, 128], the light in the moderate to infection [14, 84, 129] are infrequent, and in infections (B-III) demonstrates the need to support small antianarubak therapy. Light-moderate infections and oral agent in patients without proper absorption problems spectrum is available, with oral therapy often is appropriate especially with bwawalabla agent (A II). For the moment at least, with open wounds infected kelolatas anmakrobal therapy using limited data support the conditions (B-I) [130].

Effective number of infected diabetic feet how she lisens [131-137]; var in achieving in this specific antibiotic agent and especially artral farmkodinamak features of supply to feet instead of with diabetes [138] is associated with. Diabetic foot infection, antibiotic therapy for clinical cases, surprisingly few are printed. Many different complicated skin and soft-tissue infections antibiotics cases patients with diabetic feet, some involving patients take are included with.

In these cases, the lack of standardization makes the results of comparison of various inappropriate rigamance. Differing definitions of infection and severity of clinical end points were used in these publications is a consensus rating system highlights need to prepare for future studies as well. The combination of drugs or agents based on any single study available to others [129] high it seems.

Clinical trials have been published that are available from these agents and our collective experience and are not meant to include all reasonable conditions such as rigamance suggested. Likewise, agents, different clinical, large, can be used depending on the epidemic and financial concerns. When culture and susceptibility results are available (C-III) antibiotic therapy, consider modifying. Do not respond to antibiotic therapy of experimental options for patients that have a broad spectrum of different or more cell (B-III) (Figure 3) covered agents should include. Rigamance the increase of broad-spectrum coverage listed in approximate order. Setting priorities by the Committee indicates. After the us food and Drug Administration agents, antibiotics, drug manufacturers must be selected according to the suggestions and experience and any related Organs (especially renal) and other medical factors on the basis of the length of the penis should not be modified. Is the determination of the need for surgery. Need for many infections.

The revascolarason and masalgnmant very soft-tissue defects or mechanical lower [164-168] for the reconstruction of the nicrotik with regard to the emission of the affected tissue and drainage and the range of surgical procedures.

Unfortunately, surgical treatment of diabetic foot infections from antibiotic therapy, it does less argument [169] is based on. Life or limb-threatening infection is seeking urgent surgical consultation for

Nicrotisang faskatas, gas gangrene, as those in a large soft-tissue or compartment syndrome with or critical evidence of askhamia (A II), as well as living organ [170, 171]. The ongoing foot pain or a medical specialist patients heart and/or a deep space infection, known as deep or progressive infection seemingly appropriate medical care (Figure 3) should evaluate the face evidence is unclear. Risectance, including the timely and aggressive limited surgical amputation, more extensive dibrademant (B II) [172, 173] can reduce the need for. Pump pressure, especially in the feet can a aschimack fast and irreversible loss. The effectiveness of this surgery for patients with less serious infection medical treatment or to observe carefully and viable tissue nicrotik [174] in determining the boundary line between the delay may have to.

The blood supply of the surgeon must determine the adequacy of the remaining viable tissues, normal operating light (kompartmant feet, deep, or diagonally with the shits plantr spread between e.g., infection), and consider [175-177] finally soft-tissue cover (i.e., primary, secondary or primary intention delayed closing closing tissue transfer) for the formulation of a strategy. Should improve the possibility for healing and surgical foot level (B-II) [178] should try to preserve the integrity of the feet. In addition manual dexterity of the surgeon to decide when and how much knowledge and intervention must be experienced.

Surgeon training skills who are knowledgeable about Anatomy patovisaaloge iolsraon and infection, and with experience and enthusiasm to the field [8] is less important than his feet. In most cases, surgeon (B-III) infection control and under the influence of the injury until the patient is healing should be observed.

In some cases, amputation is the best or only option [170, 179]. Extensive necrosis or life-threatening infections at the time only [180] Quick amputation usually is required. Amputation which become recurrent iolsraon (mksmal, despite preventive measures), consideration may be given to the patient is non-

Long or deep care of the hospital on Monday or a loss event opposing [181, 182] will be needed. Of the selection consider the level of amputation vascular, by providing medical and rehabilitation issues [183, 184] to do so. Typically, the surgeon of the limb should try to save as much as possible. However, even if the results of a more active (need a prosthasas) baqimanda may be a better choice than a stump feet protection that a higher-level amputation which mechanically unsound, not healed or future possibility is on the hunt for a iolsraon. Or a part of dry gangrene, then on Monday (which is a poor option, especially for the operation for the patient) it might be better to nicrotik part aotamptty. It is also more malleable enough to not be removed easily so don't think if [80, 81] infection is one of the primary focus until adhrant aischars heel in place specifically to be the best.

The affected limb is then displayed on the vascular patient expertise be aschimack [185] should be a surgeon called with. In most cases, as a result of atherosclerosis, large vessel askhamia "instead of small vessel disease is" [68]. At the top of the left knee and ankle are relatively below the vessel for loorikstrimati angoplasti or vascular atherosclerosis may be amenable to bypass [186]. Nonkratecal askhamia (for example, those with ankle brachial artery blood pressure index 0.5-0.9 to) patients with and without vascular treatments usually can be done successfully. More severe vascular disease for diabetic patients in several centres of the foot [186-189] fimural distal bypass is successful how to abuse. A patient with severe skin infection affected a aschimack feet (i.e. within 1 – 2 days) after revascolarason any need be determined instead to perform a long (and possibly non-effective) antibiotic therapy (B-II) [123, 190] right usually delaying the process, the better. On the other hand, must be careful not to delay the affected material nicrotik dibrademant waiting for revascolarason. Procedure [191] may need multiple staged surgery, the best management.

Wound care plan format. Dibrademant additional attention is needed so that the injury early during the survey after you have performed. The bottom line is that mentally ill and dead tissue wound healing and see its potential pathogens [82, 192-194] removing a storage to enable such, kasi. Any experienced klinakian can perform limited dibrademant. They usually began as a clinic or a bed-side codes can be washing is a neuropithak without feet, especially to. Sharp scissors or tweezers, married with dibrademant tissue is usually preferable, or hydrotherapy conditions that are less definitive and dibradang agents kontrolabali and probably need it, long and applications (B-III) [194, 195] repeated. There are a lot of wound care products in different ways [17, 23, 196-199] as being able to improve healing for people, but one of them is out of the scope of our discussion. There is a way, infected sore allows daily inspection and a moist wound healing environment (B-III) encourage to be dressed. There is no evidence of any special kind of dressing faoaris. Convenience and price are important concerns. The removal of pressure a foot injury (i.e. off-loading) for the process of healing (AI) [200, 201] is very important. Many types of devices, but it can load the easy-off infected sore inspection [202], it is necessary to choose.

Adjunktowi are treated. Investigators and industry representatives wound vacuum-drainage system [203-206], recombanant growth factors [207-212], skin substitutes [203, 213 – 216], anmakrobal [217 – 219] stripes and wave (barren laroi) therapy [220-222] take care of wounds, including several types of treatment is emphasized. Although some indications for the treatment of infected wounds properly, each is likely available for routine treatment or use evidence to recommend any of the modalates provilkss is insufficient.

Adjunktowi modalates deserve two short comments. First of all, encouraging factors (G-ksafs) rndomaid granlacati colony in diabetic foot infection trials now 5 [223-found 227] to add have been investigated. An initial analysis of the meta-these cases reveals that G-CSF infection significantly speed the resolution of not operating procedures can reduce the need for (B-I) [228]. On the other hand, many anecdotal and retrospective reports Recommend that hiprbarak oxygen therapy to treat diabetic foot wounds, and a few recent prospective studies may be of value [229-232] promising results, obviously. The result of the current review on corani hiprbarak oxygen therapy for diabetic foot had an ulcer significantly [233] related to a lower risk of amputation (B-I). What additional clinical trials rndomaid only when, and what you can create with

It's expensive and limited resources protocols can be used in the treatment of diabetic foot infections. Not suitable as a substitute for traditional therapy and surgical dibrademant should be used.

Follow up

Careful observation of the sky therapy (Figure 4) the patient's response is important, and every day for anpatent and probably every 2-5 days, initially for the patient's (B-III) should be performed. The basic indicators of improvement in the resolution of the symptoms and the blood stream and systemic anti-inflammatory medical symptoms. Blood test results, including sedimentation rate [234, 235] and aritacati count obek [122, 236, 237] and C-level protein riectaoi [approximately in the year 238], anti-inflammatory markers are limited response, even though it is used for monitoring the maintenance of trust to see a lack of high level and when they do not do is a cause of anxiety for. Klinakian 4 (figures 1, 2 and 4) must complete tasks when a patient is ready for discharge or outpatient hospatalas returns, for follow up.

1. Select the exact antibiotic regimen. Culture and drug susceptibility results review and current antibiotic therapy related to inquire about any, adverse effects. Imaging, or other cultures, research and initial clinical response (C-III) on the basis of the results of a definitive antibiotic regimen (treatment including duration), select. It is not necessary to cover all makerorgansm always isolated from the cultures. More than weakness types (for example, s. aoreos and group striptcooka or B) is always covered, but should be in a paolmakrobial weakness, low bacteria infection (for example, koaglase-negative staphelokoka and antrokoka) may be less important (B II). If not responded to, the experimental regimen for protection from infection with activity against isolates select Agent. Who failed a medical therapy for the patient, steady course _ 1 for some days and then dascontanwang anmakrobalis culture (C-III) for the maximum, consider collecting specamance.

2. injury estimates again. Inspect the site to ensure that the infection is and that is the wound healing response. If not, there is a need to reassess the way surgical interventions is ongoing. There is no evidence that the whole time the wound stays open for antibiotics to supports. Anti infection biology and proposed as a medical syndrome (A-II) should be used for a specific period by. Clinical evidence of infection expected duration persists beyond the antibiotics at the same time, to check on the patient's compliance with and anadrisad negative biological factors (Figure 3). The development of antibiotic resistance, a spranfacon, a aostumilatas that the issue of deep abscess or may include more severe than, or askhamia that initially was suspected.

3. off-loading review and wound care rigamance. The effectiveness of, and compliance with, is the determination of the patient's prescribed rigamance. Advice (or query for consultation) is an alternative when necessary.

4. Review Control glikimack. To ensure the patient's blood glucose levels and other aspects of the metabolic status are controlled properly.

Aostumilatas

Diabetic foot infection may be the case with the aostumilatas [239-244] is the most difficult and controversial aspect in the management of. First of all, several issues that hinder the appearance of a lack of definition between the study and comparison of experiences is available. Next, there are many available diagnostic test, but they are often ambiguous results. Moreover, amputation and the presence of aostumilatas antibiotic therapy [240] as well as the possibility of surgical interventions, including the required period of increases. Finally, aostumilatas aoorliang wound healing ampars and recurrent infection as a focus for the works.

When the assessment is to consider. Any deep or wide as the aostumilatas had an ulcer, especially a chronic or a bony prominence (Figure 5) to consider the possible complexity of aoorlis [245]. He is suspected of the underlying aostumilatas that, when proper care and aovloadang had an ulcer after at least 6 weeks is not healed. The cord or any visible or easily had an ulcer in a barren can be palpatad with a blunt metal probe of potential. [83] by aostumilatas complex. A lambetritinang infection in patients with positive results of assessment of bone for an investigation of the test can be taken almost as much, but for test performance characteristics have not been fully explained yet again. A patient with a history of swelling in my feet, iolsraon "sausage on Monday" (i.e., red, swelling number) [246], or an undefined number of advanced obek [235] [236] inflammation markers or doubt aostumilatas (B II) should be of. Finally, radiologakall shows bone destruction is proven otherwise had an ulcer under [247] until aostumilatas should be considered to represent.

Diagnosis is confirmed. During the early stages of the disease, bony destruction usually not seen on the plain is astuarthropethe aostumilatas radevgrapei performed diagnasang time for hospital infections, neuro, first of all, there is plenty of guarantees can be difficult [pp. 248-250]. In more severe cases, simple changes to the serial on radevgrapes feature progressive [247, 251] can help. During the early stages of the disease aostumilatas radevasotope scan for detecting radevgrapes are more than sensitive, but they are expensive and can be time-consuming [252]. Nuclear medicine scan features vary according to the different types of performance, but the scan feature is low in General, bone tichnitum [240, 253-255]. MRI is the most useful Imaging modalates currently available. (A-I) [90, 92, 94, 256-259]. MRI of bone infection is the name of the most precise study for imaging, and deep soft-tissue infections provides the most reliable of the concept. All these features of the performance of diagnostic tests that are in keeping with the most likely from pratest

Aostumilatas and possible cases among [260] are the most useful for. Criteria for standard isolation of bone infections (gold) aostumilatas diagnasang (steps for using minimal pollution) hstologakal sample results obtained from cells reliably partner inflammation and ostunicrasas (B II) side. Unfortunately, few studies have evaluated the results of the diagnostic test or treatment is estimated.

This standard is used. MRI generally in cases of diabetic foot infection as the first line of investigation is not required. When a prospect is enough to get simple, often aostumilatas radevgrapes. They show no evidence of the results of the bone in the radevgrapes, a soft-tissue infections should be treated for 2 weeks for ∼ patient. Aostumilatas of doubt persists, then 2 weeks later – 4 simple radevgrapei perform. If changes to the initial aostumilatas classic movies (flashes and erosion, sclerosis, and mixed reactions outside prostal) show little, if any, and does not reflect a likely nonanfacshos astuarthropethe, HIH aostumilatas therapies, Preferably culture (B-III) after receiving the appropriate for specamance. If the results of the radevgrapei only are equal. But with no feature, aostumilatas, has one of the following options should be considered.

1. is additional imaging studies. MRI is the preferred imaging of study (which preferably newer generation leukocyte [239, 261, 262] ammnoglobolan [263, 264] use techniques or) with nuclear medicine scan is being a second choice. Imaging of blood test results are negative, then it is unlikely aostumilatas. Bone baopse aostumilatas advice, the results (see infrastructure), consider whether you need.

2. experimental treatment. Antibiotic therapy provide a and 2 – 4 weeks, and then it is bony changes (which suggest infection) then progress to determine radiograph perform.

3. bone baopse. Use a suitable procedure defined below. The combination of a sample of a bony lisaaon (or aoprataoli or prktaniosli) is in doubt after the imaging diagnosis, or aostumilatas, but did not rule out the possibility of ataalogak agent or antibiotic soscaptablates out (B-II) [251, 265-268,] are not recommended. To treat them, and often lead to amputation (ankle) for a high-profile above, it is difficult for most of the doctors now have also some mid-baopse Monday, will receive specamance hind-lisens. Any properly

Trained doctors (for example, an orthopedic surgeon, Podiatrist, radialogast-Interventional trial) can perform baopse. Prktanioos baopse should preferably be done floraskopak or under CT guidance, ananoolo skin if possible to go. Sensory neuropathy may be unnecessary for patients with washing. Bone cutting different types of needles, such as jamshada (prfacm; prapar and sons divided by the Corporation) and astecot (divide by Bard products; angomid) has been used. 2-3 specamance if possible to get at least sending 1 culture And the other for hstologakal analysis [269]. With only a few small bones bony spakolas Monday, it may be possible to aspirate. We found that the complexities of the foot bone and his baopse published reports not a safe procedure (B-II) to consider. Cultures and bone specamance [93, 268, 270] aostumilatas for patients with more accurate data than those soft problem specamance provides makrobalogak.

Medical and surgical therapy is to choose between. Traditionally authorities with chronic aostumilatas bone risictang [240, 265] was very important for the treatment have believed. Recently some surgical risecon [239] the need for routine is controversial. Ray and transmetatrsl ناجائزجنسی aostumilatas of the definitive surgical solutions such as the feet, resulting in altered Biomechanics and risk of additional periods of iolsraon architectural restructuring work. Neuropathy at least tolerable, which manages medical manifestations of God sistemitic infection aostumilatas efforts can opt out may be for the patient. On the contrary, it's the destruction of bone, also as a result of diabetic complications progressive bone soft-tissue necrosis and infection control, additional non-satisfactory or inadequate surgery is delayed or a nonhelang wound with mask. These Little or no evidence that diabetic foot aostumilatas surgical intervention to treat with some health care professionals has led to [239] the reports Published a long (3 – 6 months) course of the antibiotic nonsrgakal treatment on clinical success with 80% of 65 – ∼ [155, 173, 237, 243, 271, 276] incidents are reported. Unfortunately, these patients often aostumilatas nonrndomas case series were a definition, how to choose, whether patients were listed and how much nonopratowi dibrademant prospectaoli non-stop or even bone was performed to specify failed. Determined which patients to treat nonsrgakal, for which the duration of antibiotic therapy are important for the study of future needs, the appropriate place for night life. Meanwhile, in which nonsrgakal of aostumilatas management (B-II) could be seen as there are 4 events.

1. There is no acceptable surgical target (i.e., radical treatment of infection may not be unacceptable loss of function).

2. anreconstroktbla vascular disease by the patient, but wants to avoid amputation due to askhamia.

3. infection is limited to forephot, and the lowest is a soft-tissue loss.

4 the patient and health care professional that there is excessive risk or otherwise appropriate surgical management does not agree or preferred. When to consider a number of issues, the failure of therapy aostumilatas. First of all, The original diagnosis was correct? Another thing is that nicrotik or baqimanda must be removed or the affected bone or surgical hardware is risectad? Third, the possibility of selected antibiotics regimen kasatowi achieve the appropriate level in the organism (s) and cover the bone and it was appropriate for the duration? Fourth, the root cause of the current problem was the failure of bone infection wound? A Hampshire approach each case, usually need a surgeon in consultation with. Be patient select screen are to benefit from antibiotics (for example, embedded in sporting or on cement) [277-280] hiprbarak oxygen therapy or revascolarason, while others break or long-term antibiotic suppression is selected, or, in some cases, amputation. Selecting an antibiotic regimen. The most appropriate therapy duration of infection of diabetic feet Also describes the type of [129] is not. The amount of bone and soft tissues, and the presence of a baqimanda dead or affected status, it is necessary to consider. At least the rest of the affected tissue when antibiotic therapy is a radical risecon leaf (B-II) is required.

In spite of the affected bone or soft tissue surgery as an alternative to the long treatment is necessary is remaining constant. Aostumilatas sbopmal bwawalablati parantral something for therapy is used as an agent of, especially, can be beneficial, (C-III). Parantral therapy can be delivered to the piont where set,

Available [153, 281, 282]. Our recommendations are based on the clinical syndrome and for the duration of the therapy table 9 are tkhles.

Results

One of the objectives of the treatment of diabetic foot infection and clinical evidence of infection by the end of the soft-tissue to avoid cuts. Overall a good clinical response (i.e. clinical evidence of infection resolution) for proper treatment 80% – 90% [84, 121, 130, 263] light-moderate infections, and 60% – 80% of severe infections or aostumilatas [130, 145, 147, 237, 283] cases is expected. Factors associated with as a result of poor sistemitic infection [237], prfuon, aostumilatas [273, 283-285] insufficient limb, the presence of necrosis or gangrene [276], an inexperienced surgeon [286] [287] infection symptoms and the location are included in the combination. In rilapsas ∼ 20%-30% of patients, especially those with are located in aostumilatas. Rilapsas a different rinfacon can be difficult. In a recent survey of members of emerging infections. The network was that diabetic foot aostumilatas the average failure rate acceptable to treat 18 percent [288] found. The results of the audit and patient treatment process to manage individual practitioners and moltadaskaplanari foot care teams (B-II) may also be useful for.

Prevention

A patient that it's a good time of infection patient 1 foot [11, 289, 290] to reinforce security measures with other more is likely to make. Before that the complexities of neuropathy in the investigation of the quietness of the foot is the best way to avoid infections. Optimizing control of the glikimack patient, each time using the appropriate footwear to avoid trauma to the feet, the foot is performing daily self-examination and health care professionals any changes (A-II) for reporting about the importance of teaching. Because you may not be able to complete in the primary screening is a A few minutes away to take care of these patients take precautions clanacans feet your feet and shoes regularly and asked questions about the ' keeper ' should be strengthened by. (A-II) deal with these problems, severe neuropathy, coffee experts suitable for foot deformity or key should be referred to patients with askhamia.

Recommended research

A few recommendations for well designed and properly rndomaid are based on study strength. 6 areas in which future research will be especially useful are letters (A-3).

1. a comparative study of natural history, diagnosis and treatment of these affected feet lisens mlticantir facility as a strong, to provide the right, simple classification system is established. We had an ulcer research for international consensus feet padas is support system validation measures.

2. whether it's medical ananfactid is the determination of the role of antibiotic therapy in managing had an ulcer.

3. more and more antibiotics rigamance (duration, routes and agents) to determine different types of soft-tissue and bone Is infection.

4. in a unanimous definition of diabetic foot aostumilatas is established.

5. Design and validation of a simple, cost-effective algorithm from cid.oxfordjournals.org download adasa on August 14, 2011 at 904 • CID 2004: 39 (October 1) • lapska et al. 2006 diagnostic and treatment for infections, especially is aostumilatas.

6. compare the results of surgical and nonsrgakal management of aostumilatas.