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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Review Article

Deciphering Diabetic Foot Wounds: A Comprehensive Review on Classification, Multidrug Resistance, Microbial Insights, Management & Treatment Strategies, and Advanced Diagnostic Tools

Author(s): Susan Silvia N. and Mahalakshmi Velrajan*

Volume 21, Issue 6, 2025

Published on: 24 May, 2024

Article ID: e240524230296 Pages: 11

DOI: 10.2174/0115733998287694240514110935

Price: $65

Abstract

Diabetic foot wounds and infections pose a significant and evolving challenge in diabetes care. Diabetic wound healing has become a major global concern for a very long time. Continuous research has been conducted to increase the healing process in diabetic ulcers to the rate of amputation. Wound healing is prolonged in diabetic patients due to various conditions, such as high glucose levels, neuropathy, poor blood circulation, and prolonged inflammation around the limbs, which causes the healing to be delayed compared to normal patients. Understanding the complexity of chronic foot wounds and the management and proper treatment would lead to a decrease in the risk of amputation. The medical team all over the world is constantly researching to lower the risk.

This review paper offers a compelling journey through the multifaceted world of diabetic foot wounds and infections. It underscores the urgency of understanding classification, tackling multidrug resistance, and harnessing microbial insights to revolutionize the treatment and management of diabetic foot complications. Furthermore, it unveils state-of-the-art diagnostics, heralding a brighter future in the battle against this debilitating complication of diabetes.

Keywords: Diabetes, diabetic foot infections, diabetic foot ulcer, wound care, multidrug resistance, anaerobes, antibiotic therapy.

[1]
Levin M. Management of the diabetic foot: Preventing amputation. South Med J 2002; 95(1): 10-20.
[http://dx.doi.org/10.1097/00007611-200295010-00004] [PMID: 11827238]
[2]
Boulton AJM, Vileikyte L, Tennvall RG, Apelqvist J. The global burden of diabetic foot disease. Lancet 2005; 366(9498): 1719-24.
[http://dx.doi.org/10.1016/S0140-6736(05)67698-2] [PMID: 16291066]
[3]
Heinrich M, Foreword ADK, Epilogue JDP, Maizels I. by D.; Gibbons, S. J Pharmacogn Phytother 2004.
[4]
Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med 2005; 16(8): 567-70.
[http://dx.doi.org/10.1016/j.ejim.2005.06.016] [PMID: 16314237]
[5]
Bandyk DF. The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg 2018; 31(2-4): 43-8.
[http://dx.doi.org/10.1053/j.semvascsurg.2019.02.001] [PMID: 30876640]
[6]
Lipsky BA, Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36(S1)e3280
[http://dx.doi.org/10.1002/dmrr.3280] [PMID: 32176444]
[7]
Nicolucci Ac. Fact and figures about diabetes in Italy. Assist Inferm Ric 2011; 30(2): 100-6.
[http://dx.doi.org/10.1702/845.9396] [PMID: 21747574]
[8]
Burgess JL, Wyant WA, Abujamra BA, Kirsner RS, Jozic I. Diabetic Wound-Healing. Science Medicina 2021; 57(10): 1072.
[http://dx.doi.org/10.3390/medicina57101072]
[9]
Chang M, Nguyen TT. Strategy for treatment of infected diabetic foot ulcers. Acc Chem Res 2021; 54(5): 1080-93.
[http://dx.doi.org/10.1021/acs.accounts.0c00864] [PMID: 33596041]
[10]
Vijayakumar V, Samal SK, Mohanty S, Nayak SK. Recent advancements in biopolymer and metal nanoparticle-based materials in diabetic wound healing management. Int J Biol Macromol 2019; 122: 137-48.
[http://dx.doi.org/10.1016/j.ijbiomac.2018.10.120] [PMID: 30342131]
[11]
Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population‐based cohort from the United Kingdom. Diabet Med 2016; 33(11): 1493-8.
[http://dx.doi.org/10.1111/dme.13054] [PMID: 26666583]
[12]
Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13(12): 1049-65.
[http://dx.doi.org/10.4239/wjd.v13.i12.1049] [PMID: 36578871]
[13]
Sharifirad G, Shojaezadeh D, Tavasoli E, Azadbakht L, Tol A. Socio-economic factors and diabetes consequences among patients with type 2 diabetes. J Educ Health Promot 2013; 2(1): 12.
[http://dx.doi.org/10.4103/2277-9531.108009] [PMID: 24083262]
[14]
Pitocco D, Tesauro M, Alessandro R, Ghirlanda G, Cardillo C. Oxidative stress in diabetes: Implications for vascular and other complications. Int J Mol Sci 2013; 14(11): 21525-50.
[http://dx.doi.org/10.3390/ijms141121525] [PMID: 24177571]
[15]
Shaw JE, Zimmet P. The epidemiology of diabetic neuropathy. Diabetes Rev 1999; 7(4): 245-52.
[16]
Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: Are diabetes‐related wounds and amputations worse than cancer? Int Wound J 2007; 4(4): 286-7.
[http://dx.doi.org/10.1111/j.1742-481X.2007.00392.x] [PMID: 18154621]
[17]
Aguila DMA, Reiber GE, Koepsell TD. How does provider and patient awareness of high-risk status for lower-extremity amputation influence foot-care practice? Diabetes Care 1994; 17(9): 1050-4.
[http://dx.doi.org/10.2337/diacare.17.9.1050] [PMID: 7988305]
[18]
Chao CYL, Cheing GLY. Microvascular dysfunction in diabetic foot disease and ulceration. Diabetes Metab Res Rev 2009; 25(7): 604-14.
[http://dx.doi.org/10.1002/dmrr.1004] [PMID: 19681035]
[19]
Gershater MA, Löndahl M, Nyberg P, et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: A cohort study. Diabetologia 2009; 52(3): 398-407.
[http://dx.doi.org/10.1007/s00125-008-1226-2] [PMID: 19037626]
[20]
Boulton AJM, Kirsner RS, Vileikyte L. Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 2004; 351(1): 48-55.
[http://dx.doi.org/10.1056/NEJMcp032966] [PMID: 15229307]
[21]
LoGerfo FW, Coffman JD. Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care. N Engl J Med 1984; 311(25): 1615-9.
[http://dx.doi.org/10.1056/NEJM198412203112506] [PMID: 6390204]
[22]
Mehraj DM. A review of Wagner classification and current concepts in management of diabetic foot. Int J Orthopaedics Sci 2018; 4(1n): 933-5.
[http://dx.doi.org/10.22271/ortho.2018.v4.i1n.133]
[23]
Shigematsu K. Surgical management of the diabetic foot. Clin Calcium 2003; 13(9): 1179-84.
[24]
Wagner FW Jr. The dysvascular foot: A system for diagnosis and treatment. Foot Ankle 1981; 2(2): 64-122.
[http://dx.doi.org/10.1177/107110078100200202] [PMID: 7319435]
[25]
Zubair M. Diabetic foot ulcer: A review. American J Int Med 2015; 3(2): 28.
[http://dx.doi.org/10.11648/j.ajim.20150302.11]
[26]
Khan Y, Khan MM, Farooqui M. Diabetic foot ulcers: A review of current management. Int J Res Med Sci 2017; 5(11): 4683.
[http://dx.doi.org/10.18203/2320-6012.ijrms20174916]
[27]
Robinson AHN, Pasapula C, Brodsky JW. Surgical aspects of the diabetic foot. J Bone Joint Surg Br 2009; 91-B(1): 1-7.
[http://dx.doi.org/10.1302/0301-620X.91B1.21196] [PMID: 19091997]
[28]
Santema TB, Lenselink EA, Balm R, Ubbink DT. Comparing the Meggitt‐Wagner and the University of Texas wound classification systems for diabetic foot ulcers: Inter‐observer analyses. Int Wound J 2016; 13(6): 1137-41.
[http://dx.doi.org/10.1111/iwj.12429] [PMID: 25720543]
[29]
Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg 1996; 35(6): 528-31.
[http://dx.doi.org/10.1016/S1067-2516(96)80125-6] [PMID: 8986890]
[30]
Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJM. A comparison of two diabetic foot ulcer classification systems: The Wagner and the University of Texas wound classification systems. Diabetes Care 2001; 24(1): 84-8.
[http://dx.doi.org/10.2337/diacare.24.1.84] [PMID: 11194247]
[31]
Jain A, Joshi S. Diabetic Foot Classifications: Review of Literature. Med Sci 2013; 2(3): 715.
[http://dx.doi.org/10.5455/medscience.2013.02.8069]
[32]
Chastain CA, Klopfenstein N, Serezani CH, Aronoff DM. A clinical review of diabetic foot infections. Clin Podiatr Med Surg 2019; 36(3): 381-95.
[http://dx.doi.org/10.1016/j.cpm.2019.02.004] [PMID: 31079605]
[33]
Banu A, Hassan MMN, Rajkumar J, Srinivasa S. Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study. Australas Med J 2015; 8(9): 280-5.
[http://dx.doi.org/10.4066/AMJ.2015.2422] [PMID: 26464584]
[34]
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006; 29(6): 1288-93.
[http://dx.doi.org/10.2337/dc05-2425] [PMID: 16732010]
[35]
Rubeaan AK, Derwish AM, Ouizi S, et al. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One 2015; 10(5)e0124446
[http://dx.doi.org/10.1371/journal.pone.0124446] [PMID: 25946144]
[36]
Ndosi M, Hughes WA, Brown S, et al. Prognosis of the infected diabetic foot ulcer: A 12‐month prospective observational study. Diabet Med 2018; 35(1): 78-88.
[http://dx.doi.org/10.1111/dme.13537] [PMID: 29083500]
[37]
Lipsky BA, Berendt AR, Cornia PB, et al. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012; 54(12): e132-73.
[http://dx.doi.org/10.1093/cid/cis346] [PMID: 22619242]
[38]
Bader MS. Diabetic foot infection Available from: https://www.aafp.org/pubs/afp/issues/2008/0701/p71.html
[39]
Shettigar S, Shenoy S, Sevitha S, Rao P. Microbiological profile of deep tissue and bone tissue in diabetic foot osteomyelitis. J Clin Diagn Res 2018; 12(6): DC20-2.
[http://dx.doi.org/10.7860/JCDR/2018/35462.11597]
[40]
Abdulrazak A, Bitar IZ, Al-Shamali AA, Mobasher AL. Bacteriological study of diabetic foot infections. J Diabetes Compl 2005; 19(3): 138-41.
[http://dx.doi.org/10.1016/j.jdiacomp.2004.06.001] [PMID: 15866058]
[41]
Charles PGP, Uçkay I, Kressmann B, Emonet S, Lipsky BA. The role of anaerobes in diabetic foot infections. Anaerobe 2015; 34: 8-13.
[http://dx.doi.org/10.1016/j.anaerobe.2015.03.009] [PMID: 25841893]
[42]
Gerding DN. Foot infections in diabetic patients: The role of anaerobes. Clin Infect Dis 1995; 20(S2): S283-8.
[http://dx.doi.org/10.1093/clinids/20.Supplement_2.S283] [PMID: 7548576]
[43]
Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther 2013; 11(3): 297-308.
[http://dx.doi.org/10.1586/eri.13.12] [PMID: 23458769]
[44]
Rastogi A, Sukumar S, Hajela A, et al. The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: A prospective study from India. J Diabetes Complications 2017; 31(2): 407-12.
[http://dx.doi.org/10.1016/j.jdiacomp.2016.11.001] [PMID: 27894749]
[45]
Manikandan C, Amsath A. Antibiotic susceptibility of bacterial strains isolated from wound infection patients in Pattukkottai , Tamilnadu, India. Available from:. https://www.semanticscholar.org/paper/Antibiotic-susceptibility-of-bacterial-strains-from-Manikandan-Amsath/845cd719476ee8ec5cca28e086969ad5cf2f407c
[46]
Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006; 29(8): 1727-32.
[http://dx.doi.org/10.2337/dc06-0116] [PMID: 16873771]
[47]
Henig O, Pogue JM, Martin E, et al. The impact of Multidrug-Resistant organisms on outcomes in patients with diabetic foot infections. Open Forum Infect Dis 2020; 7(5)ofaa161
[http://dx.doi.org/10.1093/ofid/ofaa161] [PMID: 32500092]
[48]
Dang CN, Prasad YDM, Boulton AJM, Jude EB. Methicillin‐resistant Staphylococcus aureus in the diabetic foot clinic: A worsening problem. Diabet Med 2003; 20(2): 159-61.
[http://dx.doi.org/10.1046/j.1464-5491.2003.00860.x] [PMID: 12581269]
[49]
Shahi SK, Kumar A. Isolation and Genetic Analysis of Multidrug Resistant Bacteria from Diabetic Foot Ulcers. Front Microbiol 2016; 6: 1464.
[http://dx.doi.org/10.3389/fmicb.2015.01464] [PMID: 26779134]
[50]
Shaheen MMA, Dahab AS, Fada AM, Idieis R. Isolation and characterization of bacteria from diabetic foot ulcer: Amputation, antibiotic resistance and mortality rate. Int J Diabetes Dev Ctries 2022; 42(3): 529-37.
[http://dx.doi.org/10.1007/s13410-021-00997-7] [PMID: 34522073]
[51]
Atlaw A, Kebede HB, Abdela AA, Woldeamanuel Y. Bacterial isolates from diabetic foot ulcers and their antimicrobial resistance profile from selected hospitals in Addis Ababa, Ethiopia. Front Endocrinol 2022; 13987487
[http://dx.doi.org/10.3389/fendo.2022.987487] [PMID: 36120451]
[52]
Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot 2011; 21(1): 6-14.
[http://dx.doi.org/10.1016/j.foot.2010.10.003] [PMID: 21130641]
[53]
Rathnayake A, Saboo A, Malabu UH, Falhammar H. Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review. World J Diabetes 2020; 11(9): 391-9.
[http://dx.doi.org/10.4239/wjd.v11.i9.391] [PMID: 32994867]
[54]
Seaman S. The role of the nurse specialist in the care of patients with diabetic foot ulcers. Foot Ankle Int 2005; 26(1): 19-26.
[http://dx.doi.org/10.1177/107110070502600104] [PMID: 15680114]
[55]
Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. J Vasc Surg 2020; 71(4): 1433-1446.e3.
[http://dx.doi.org/10.1016/j.jvs.2019.08.244] [PMID: 31676181]
[56]
Hasan R, Firwana B, Elraiyah T, et al. A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome. J Vasc Surg 2016; 63(2): 22S-28S.e2..
[http://dx.doi.org/10.1016/j.jvs.2015.10.005]
[57]
Patil MD, Gunasekaran U, Fontaine JL, Meneghini L. Does improving glycemic control accelerate healing of diabetic foot ulcers? Diabetes 2018; 67(S1): 2218-PUB.
[http://dx.doi.org/10.2337/db18-2218-PUB]
[58]
Ayala TMÁ, Rojas GA. Association between peripheral arterial disease and diabetic foot ulcers in patients with diabetes mellitus type 2. Medicina Universitaria 2017; 19(76): 123-6.
[http://dx.doi.org/10.1016/j.rmu.2017.07.002]
[59]
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). . Available from: https://pubmed.ncbi.nlm.nih.gov/9742977
[60]
Marso SP, Hiatt WR. Peripheral arterial disease in patients with diabetes. J Am Coll Cardiol 2006; 47(5): 921-9.
[http://dx.doi.org/10.1016/j.jacc.2005.09.065] [PMID: 16516072]
[61]
Addendum 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes. Diabetes Care 2021; 44(S1): S151-67.
[http://dx.doi.org/10.2337/dc21-ad09b] [PMID: 34135018]
[62]
Schaper NC, Andros G, Apelqvist J, et al. Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev 2012; 28(S1): 236-7.
[http://dx.doi.org/10.1002/dmrr.2252] [PMID: 22271745]
[63]
Schaper NC, Andros G, Apelqvist J, et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2012; 28(S1): 218-24.
[http://dx.doi.org/10.1002/dmrr.2255] [PMID: 22271741]
[64]
Boulton A, Armstrong D, Krisner R, et al. Diagnosis and management of diabetic foot complications. ADA Clinical Compendia 2018; 2018(2): 1-20.
[http://dx.doi.org/10.2337/db20182-1] [PMID: 30958663]
[65]
Guthrie H, Clasper J. Historical origins and current concepts of wound debridement. J R Army Med Corps 2011; 157(2): 130-2.
[http://dx.doi.org/10.1136/jramc-157-02-01] [PMID: 21805760]
[66]
Attinger CE, Dučić I, Zelen CM. The use of local muscle flaps in foot and ankle reconstruction Elsevier eBooks 2012; pp. 269-88..
[http://dx.doi.org/10.1016/B978-0-7020-3136-6.00023-0]
[67]
Lipsky BA, Sánchez AJ, Diggle M, et al. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 2016; 32(S1): 45-74.
[http://dx.doi.org/10.1002/dmrr.2699] [PMID: 26386266]
[68]
Sánchez AJ, Martínez LLJ, Duque PJ, Maynar M. From the diabetic foot ulcer and beyond: How do foot infections spread in patients with diabetes? Diabet Foot Ankle 2012; 3(1): 18693.
[http://dx.doi.org/10.3402/dfa.v3i0.18693] [PMID: 23050067]
[69]
Diabetes-Related Foot Infections. Diagnosis and treatment Available from: https://pubmed.ncbi.nlm.nih.gov/34652105/
[70]
Pereira SG, Moura J, Carvalho E, Empadinhas N. Microbiota of Chronic Diabetic Wounds: Ecology, Impact, and Potential for Innovative Treatment Strategies. Front Microbiol 2017; 8: 1791.
[http://dx.doi.org/10.3389/fmicb.2017.01791] [PMID: 28983285]
[71]
Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev 2024; 40(3)e3687
[http://dx.doi.org/10.1093/cid/ciad527] [PMID: 37779457]
[72]
Lavery LA, Fontaine JL, Bhavan K, Kim PJ, Williams JR, Hunt NA. Risk factors for methicillin-resistant Staphylococcus aureus in diabetic foot infections. Diabet Foot Ankle 2014; 5(1): 23575.
[http://dx.doi.org/10.3402/dfa.v5.23575] [PMID: 24765246]
[73]
Elias B. Diabetic Foot Infections: An Update on Treatment. US Pharm 2013; 38(4): 23-6. Available from : https://www.uspharmacist.com/article/diabetic-foot-infections-anupdate-on-treatment
[74]
Tayeb K. Managing infection: A holistic approach. J Wound Care 2015; 24(S5b): 20-30.
[http://dx.doi.org/10.12968/jowc.2015.24.Sup5b.20]
[75]
Lipsky BA, Hiatt HI, Holroyd KJ. Results and prognostic value of Gram stain of tissue curettage specimens of infected diabetic foot ulcers [abstract 145] In: Proceedings of the 37th annual meeting of the Infectious Diseases Society of America. Alexandria, VA: Infectious Diseases Society of America 1999.
[76]
Tentolouris N, Petrikkos G, Vallianou N, et al. Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect 2006; 12(2): 186-9.
[http://dx.doi.org/10.1111/j.1469-0691.2005.01279.x] [PMID: 16441460]
[77]
Lipsky BA. Medical treatment of diabetic foot infections. Clin Infect Dis 2004; 39(S2): S104-14.
[http://dx.doi.org/10.1086/383271] [PMID: 15306988]
[78]
Armstrong DG, Lipsky BA. Diabetic foot infections: Stepwise medical and surgical management. Int Wound J 2004; 1(2): 123-32.
[http://dx.doi.org/10.1111/j.1742-4801.2004.00035.x] [PMID: 16722884]
[79]
Selva A, Solà I, Nava BLA, Gianneo OD, Cosp XB, Lipsky BA. Systemic antibiotics for treating diabetic foot infections. Cochrane Database Syst Rev 2015; 2015(9)CD009061
[http://dx.doi.org/10.1002/14651858.CD009061.pub2]
[80]
Roberts AD, Simon GL. Diabetic foot infections: The role of microbiology and antibiotic treatment. Semin Vasc Surg 2012; 25(2): 75-81.
[http://dx.doi.org/10.1053/j.semvascsurg.2012.04.010] [PMID: 22817856]
[81]
Peszynska MJ, Sass M, Schipper S, et al. Pharmacokinetics and penetration of moxifloxacin into infected diabetic foot tissue in a large diabetic patient cohort. Eur J Clin Pharmacol 2011; 67(2): 135-42.
[http://dx.doi.org/10.1007/s00228-010-0903-5] [PMID: 20871984]
[82]
Chapman ALN, Dixon S, Andrews D, Lillie PJ, Bazaz R, Patchett JD. Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): A UK perspective. J Antimicrob Chemother 2009; 64(6): 1316-24.
[http://dx.doi.org/10.1093/jac/dkp343] [PMID: 19767623]
[83]
Marvaso A, Esposito S, Noviello S, Petronella P. Outpatient Parenteral Antibiotic Therapy (OPAT) of diabetic foot infections with piperacillin/tazobactam. Infez Med 2002; 10(4): 230-5.
[84]
Kucers’ The Use of Antibiotics Sixth Edition. Available from: https://www.amazon.com/Kucers-Use-Antibiotics-Sixth-Antibacterial/dp/0340927674
[85]
Tascini C, Piaggesi A, Tagliaferri E, et al. Microbiology at first visit of moderate-to-severe diabetic foot infection with antimicrobial activity and a survey of quinolone monotherapy. Diabetes Res Clin Pract 2011; 94(1): 133-9.
[http://dx.doi.org/10.1016/j.diabres.2011.07.017] [PMID: 21824673]
[86]
Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis 2009; 49(10): 1541-9.
[http://dx.doi.org/10.1086/644732] [PMID: 19842981]
[87]
Gottrup F, Apelqvist J, Bjarnsholt T, et al. EWMA Document: Antimicrobials and Non-healing Wounds: Evidence, controversies and suggestions. J Wound Care 2013; 22(S5): S1-S89.
[http://dx.doi.org/10.12968/jowc.2013.22.Sup5.S1]
[88]
Lipsky BA, Holroyd KJ, Zasloff M. Topical versus systemic antimicrobial therapy for treating mildly infected diabetic foot ulcers: A randomized, controlled, double-blinded, multicenter trial of pexiganan cream. Clin Infect Dis 2008; 47(12): 1537-45.
[http://dx.doi.org/10.1086/593185] [PMID: 18990064]
[89]
Wang CL, Cohan RH, Ellis JH, Caoili EM, Wang G, Francis IR. Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions. AJR Am J Roentgenol 2008; 191(2): 409-15.
[http://dx.doi.org/10.2214/AJR.07.3421] [PMID: 18647910]
[90]
Boulton AJM, Rayman G, Wukich DK. The foot in diabetes. John Wiley & Sons 2020.
[http://dx.doi.org/10.1002/9781119445821]
[91]
Sheleg AE, Keidar Z. Diabetic foot infection: The role of PET/CT imaging. Curr Pharm Des 2018; 24(12): 1277-86.
[http://dx.doi.org/10.2174/1381612824666180227095439] [PMID: 29484984]
[92]
Suresh K, Kumar A. Assessment of Diabetic Foot through the Developmental Stages of Lower Limb Abnormalities Using UltrasoundIntechOpen eBooks 2020
[http://dx.doi.org/10.5772/intechopen.92431]
[93]
Dyet JF, Nicholson AA, Ettles DFE. Vascular imaging and intervention in peripheral arteries in the diabetic patient. Diabetes Metab Res Rev 2000; 16(S1): S16-22.
[http://dx.doi.org/10.1002/1520-7560(200009/10)16:1+<:AID-DMRR131>3.0.CO;2-W] [PMID: 11054882]
[94]
Palestro CJ, Love C. Nuclear medicine and diabetic foot infections. Semin Nucl Med 2009; 39(1): 52-65.
[http://dx.doi.org/10.1053/j.semnuclmed.2008.08.006] [PMID: 19038600]
[95]
Martín J, Saleem N. 18F-FDG PET-CT scanning and diabetic patients. Nucl Med Commun 2014; 35(12): 1197-203.
[http://dx.doi.org/10.1097/MNM.0000000000000197] [PMID: 25211626]
[96]
Low KT, Peh WC. Magnetic resonance imaging of diabetic foot complications. Singapore Med J 2015; 56(1): 23-34.
[http://dx.doi.org/10.11622/smedj.2015006] [PMID: 25640096]
[97]
Uçkay I, Sánchez AJ, Lew D, Lipsky BA. Diabetic foot infections: What have we learned in the last 30 years? Int J Infect Dis 2015; 40: 81-91.
[http://dx.doi.org/10.1016/j.ijid.2015.09.023] [PMID: 26460089]
[98]
Ankrah AO, Klein HC, Elsinga PH. New imaging tracers for the infected diabetic foot (Nuclear and Optical Imaging). Curr Pharm Des 2018; 24(12): 1287-303.
[http://dx.doi.org/10.2174/1381612824666180227094454] [PMID: 29484983]
[99]
Lambrecht FY. Evaluation of 99mTc-labeled antibiotics for infection detection. Ann Nucl Med 2011; 25(1): 1-6.
[http://dx.doi.org/10.1007/s12149-010-0417-3] [PMID: 20927661]
[100]
Dutta P, Bhansali A, Mittal BR, Singh B, Masoodi SR. Instant 99mTc-ciprofloxacin scintigraphy for the diagnosis of osteomyelitis in the diabetic foot. Foot Ankle Int 2006; 27(9): 716-22.
[http://dx.doi.org/10.1177/107110070602700911] [PMID: 17038284]
[101]
Sellmyer MA, Lee I, Hou C, et al. Bacterial infection imaging with [18F]fluoropropyl-trimethoprim. Proc Natl Acad Sci 2017; 114(31): 8372-7.
[http://dx.doi.org/10.1073/pnas.1703109114] [PMID: 28716936]
[102]
Ferreira IM, Lacerda SCM, dos Santos SR, et al. Detection of bacterial infection by a technetium-99m-labeled peptidoglycan aptamer. Biomed Pharmacother 2017; 93: 931-8.
[http://dx.doi.org/10.1016/j.biopha.2017.07.017] [PMID: 28715874]
[103]
van Oosten M, Schäfer T, Gazendam JAC, et al. Real-time in vivo imaging of invasive- and biomaterial-associated bacterial infections using fluorescently labelled vancomycin. Nat Commun 2013; 4(1): 2584.
[http://dx.doi.org/10.1038/ncomms3584] [PMID: 24129412]
[104]
Rubitschung K, Sherwood A, Crisologo AP, et al. Pathophysiology and molecular imaging of diabetic foot infections. Int J Mol Sci 2021; 22(21): 11552.
[http://dx.doi.org/10.3390/ijms222111552] [PMID: 34768982]

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