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IWGDF guide: diagnosis and treatment of diabetic foot infection

Guide: In 2019, the International Diabetes Football Working Group (IWGDF) released the diagnosis and treatment guidelines for the foot infection of diabetic patients. This article is an update of the 2015 IWGDF infection guide. 27 recommendations, the content covers all aspects of soft tissue and bone infection diagnosis. The editor sorted out as follows.


a) Diagnosis of diabetic feet soft tissue infection in clinical clinical diabetes should be based on the signs and symptoms of local or systemic inflammatory infections. (Grade recommendation: strong, evidence quality: low)

b) The infection table of the infection of the International Working Group of the American Infectious Diseases or diabetic football team is used to evaluate the severity of any diabetic foot infection. (Strong, medium)


When a severe foot infection occurs in diabetes, and the moderate infection is complicated or merged with major complications, hospitalization treatment needs to be considered. (Strong, low)


When a clinical examination may not be confirmed after a clinical examination may be performed, serum inflammatory biomarkers should be considered after a clinical examination of diabetes. (Weak, low)


Those who have neither electronic measurement foot temperature nor using quantitative microbial analysis to prove that it can be used as a diagnosis of diabetic foot infection. We recommend not to use it. (Weak, low)


When diabetic patients are suspected of osteomyelitis in the foot, it is recommended to conduct a probe to detect the test of bone. The red blood cell settlement rate (or C-reactive protein or calculin original) and X-flat tablets are supported by the preliminary evidence of diagnosis of osteomyelitis. (Strong, medium)


a) For patients with suspected osteomyelitis in diabetes, if X -flat tablets and clinical symptoms and laboratory examinations are consistent with osteomyelitis, it is not recommended to further do foot imaging to confirm the diagnosis (strong, low).

b) If there are still doubts about the diagnosis of osteomyelitis, further imaging examinations can be considered, such as magnetic resonance imaging scanning, 18F-FDG-positive electronic transmitting fault scanning/calculation fault scan (CT) or white blood cell marks (adopted use Or do not use CT). (Strong, medium)


For patients with suspected osteomyelitis in diabetes, when choosing a diagnosis or determining the pathogenic lesion, the bone specimen can be obtained through the skin or surgical method, or the clinical -related bone microbial culture or tissue pathological test can be performed. (Strong, low)


a) Almost all clinical infection wounds should be collected in proper cultivation specimens to determine the pathogenic disease. (Strong, low)

b) For infection with soft tissue in diabetes, a sterile specimens should be obtained from the ulcer (the method of scraping or biopsy). (Strong, medium)


Do not use molecular microbiological technology (rather than traditional culture method) to confirm the front -line method of diabetic foot disease infection with specimen disease. (Strong, low)


The antibiotics selected for the treatment of diabetic foot infections are proven to be effective and suitable for individual patients in published random control tests. Some drugs that can be considered include: penicillin, cephalosporins, carbonicone, metronidazole (combined with other antibiotics), clromycin, ronazole, tedomycin Jointly use, or use vanomycin, but cannot be used for polyps. (Strong, high)


Based on the following situations, antibiotics used to treat diabetic foot infection: may or prove that pathogenic sensitivity to the pathogen and its antibiotics; the clinical severity of infection; Including the impact of the antibiotics on the symbiotic flora; the interaction of the drug; the drug can be obtained and its cost. (Strong, medium)


If antibiotics are first treated in patients with severe diabetic feet infection, if the patient’s clinical symptoms are improved, there is no taboos of oral drug treatment, and oral drugs that can be selected. Essence (Strong, low)


Patients with mild and most moderate diabetic foot infection, even if the symptoms of intravenous injection are used for the first time, it is recommended to take oral antibiotics. (Weak, low)


We recommend that you do not use any existing local antibacterial agent to treat mild diabetes foot infections. (Weak, medium)


a) Antibiotics should be continued for 1-2 weeks of antibiotic treatment for the skin or soft tissue infection of patients with diabetic foot. (Strong, high)

b) If the infection is improved, but the infection is slower than expected, or the patient has severe peripheral artery diseases. It can consider continuing treatment. The treatment cycle can reach up to 3-4 weeks. (Weak; Low)

c) If the infection is not controlled after 4 weeks of treatment, it is necessary to re -evaluate and consider further diagnosis and change treatment plan. (Strong, low)


Diabetic patients living in temperate areas, if there are mild diabetes foot infections and have not been treated with antibiotics recently, you can perform experiential antibiotic treatment. Choose the Aerobic Gram-positive pathogen (β-link bacteria and Staphylococcus aureus). Antibiotic treatment. (Strong, low)


For patients living in tropical/subtropical climate areas or patients who have received antibiotics in the past few weeks, if there is severe limb ischemia or moderate or severe infection, we recommend choosing a broad -spectrum (covering the Gram -positive pathogen) The antibiotics are used for experience, and the separate Gram -negative pathogen (specialty anaerobic bacteria) infection may exist in a medium to severe infection case. The antibiotics treatment plan should be considered according to the results of clinical and drug sensitivity tests. (Weak, low) 18

Under the temperate climate, there is usually no need to treat copper -green single -bacteria experience, but patients with moderate or severe infection If the specimen is cultivated to separate copper -green monolithic bacteria or patients in the tropical/subtropical climate area in the past few weeks, It is necessary to consider experience treatment for copper -green monolithic bacteria. (Weak, low)


Do not clinically do not infected foot ulcers. Do not use antibiotic therapy for the whole body or local to reduce the risk of infection or promote ulcer healing. (Strong, low)


Under the absence of severe infection, moderate infection with extensive gangrene, necrotic infection, deep part (under the fascia) abscesses, intervals syndrome, or severe lower limb ischemia, non -surgeon should urgently consult surgery experts. (Strong, low)

twenty one

a) Patients with diabetic patients with forefoot osteomyelitis have antibiotic treatment without surgical treatment without surgical treatment without surgical removal of bone. (Strong, medium)

b) Patients with diabetic foot osteitis and accompanied by soft tissue infection may be urgently evaluated whether surgery requires surgery, as well as surgical treatment and postoperative medical measures. (Strong, medium)

twenty two

The choice of antibiotic drugs that have been confirmed in clinical studies that have been effectively effective for osteomyelitis are used to treat diabetic foot bone marrowitis. (Strong, low)

twenty three

a) Treatment of diabetic osteomyelitis with antibiotics does not exceed 6 weeks. If the infection symptoms have not improved within the first 2-4 weeks, we should consider reorganizing the bone specimen that needs to be used for cultivation, surgical resection or replacement of antibiotic use schemes. (Strong, medium)

b) If there is no soft tissue infection and all infected bones have been removed by surgical, antibiotic treatment of diabetic foot osteitis only takes a few days. (Weak, low)

twenty four

For cases of diabetic foot osteitis that initially needed gastrointestinal treatment, when considering using an oral antibiotic solution, there may be 5-7 days of high biological utilization. Oral treatment of clinical symptoms can be used for oral therapy. (Weak, medium)


a) Patients with osteomyelitis in diabetic foot will be carried out when bone resection surgery, considering obtaining the corresponding skeletal specimens at the dispelctiatal residue (may also perform histopathological examinations if possible) to determine whether there are residual end bone infections. (Weak, medium)

b) If a sterile collected specimens obtained during the surgery, the specimens of specimens produce pathogens, or tissue confirms osteomyelitis, and proper antibiotic treatment for 6 weeks. (Strong, medium)


For diabetic foot infections, do not use high -pressure oxygen therapy or local oxygen therapy (the only indication is specifically used for treatment infection). (Weak, low)


Specializing in the infection of foot ulcer for diabetes:

<!-2586: Diabetic terminal page

a) Do not use auxiliary granulocytes to set the stimulus factor. (Weak, moderate)

b) Do not use local preservatives, silver agents, honey, phage treatment or negative pressure wound therapy (with or without autocracy). (Weak, low)

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