Diabetic foot infections

Diabetic foot problems are a major cause of hospitalization, with immense personal and economic consequences. Twenty percent of all diabetic patients enter the hospital due to foot problems at a certain point in their lifetime. Foot ulcers are the most representative lesions and are responsible for one out of four hospitalizations in subjects with diabetes (1-4). These lesions are most often the result of peripheral neuropathy, autonomic neuropathy, and peripheral vascular disease. Infection is a very frequent component of them and it is certainly a significant determinant of outcome. In a case control study by Reiber et aI., infection was a significant predisposing factor for amputation in 68% of the cases (5). In a study conducted by Pecoraro et al, in a series of 80 male veterans, it was determined that infection played a role in the need for lower extremity amputation in 59% of the cases (6). Therefore, infected ulcers, especially in combination with peripheral vascular disease, can sometimes evolve to limbor life-threatening events which frequently result in amputation of the lower extremity. The risk of amputation is in fact 15-40 times higher in diabetic patients than in the nondiabetic population, and 40%-45% of patients undergoing nontraumatic amputation are diabetic (1). Surgical complications and mortality are also increased in diabetic patients: Half of those who undergo amputation die within 3 years (2). The economic costs associated with diabetic foot complications and amputations are astronomical. Direct hospital costs alone in the United States exceeded $200 million a year in 1980. This figure does not include other direct medical expenses or indirect costs due to disability