Skin bone and joint bacterial infections in the diabetic foot: Role of infection

A major problem: Two-thirds of ail amputations involve infection. infection is favored by dysfunction of the antibacterial defense systems due to high blood glucose and vascular disorders. Diagnosis: General signs of infection are usually not found. A careful expl oration is required to rule out or confirm osteitis in order to guide surge ry and plan the antibiotic regimen. A history of chronic and/or recurrent u lceration or direct signs at inspection may be suggestive of osteitis. Radi ographic signs are late and nonspecific Scintigraphy scans are difficult to interprete, Magnetic resonance imaging can be quire helpful in difficult c ases. I Bacteriological proof: Staphylococcus aureus and to a lesser extent strepto cocci account for almost all of the superficial infections in the diabetic loot In case of deep ulceration, it is important to obtain deep specimens a t surgical cleansing as more superficial samples are easily contaminated. N evertheless, if Staphylococcus aureus is isolated from pus coming from a de ep zone fistulizing to the skin, it is likely the causal agent since 80% of all bone infections involve S.aureus. Other germs besides staphylococci an d steptococci include enterobacteria (40%), enterococci (26%) and pseudomon as (7%). Several germs are involved in about 70% of cases with a probable s ynergetic effect between the different bacterial colonies within the infect ed tissues.