Demystifying infection in the diabetic foot

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diabetes, Diabetic foot, Editor's Pick, Infection

Demystifying infection in the diabetic foot

Jacqui Fletcher, Michael Edmonds, Jennifer Madden, Louise Morris, Ngwe Phyo, Debbie Sharman, Stephanie Stanley, Mel Stevens, Frank Webb, Deborah Wilson, Peter Yew

6 November 2024

There are over 5 million people living with diabetes in the UK (Diabetes UK, 2023), with the global diabetes prevalence rising rapidly. The total number of people living with diabetes increased from 108 million in 1980 to 422 million in 2014 (World Health Organization, 2023). In 2021, approximately 537 million adults (aged 20-79 years) were living with diabetes, a number projected to rise to 783 million in 2045 (Sun et al, 2022). Diabetes can lead to several complications and increases a patient’s infection risk by 1.5–4 times, with a higher risk of infection in the extremities (Edmonds et al, 2021; Holt et al, 2024). With diabetes, there is a lifetime risk of up to 34% of developing foot ulcers, at least half of which develop an infection (Edmonds et al, 2021).

In this backdrop, it is no surprise that up to the year 2012, the global rate of lower limb amputations was approximately one every 20 seconds (Edmonds et al, 2021). Healthcare professionals (HCPs) label a diabetic foot infection (DFI) an ‘immediate threat’ to a person with diabetes (International Working Group on the Diabetic Foot [IWGDF] Practical Guidelines, 2023).

Diabetes pathology increases patient susceptibility to both infections and a faster rate of infection spread, making timely identification and intervention a crucial step. This situation is exacerbated by the fact that symptoms of a newly developed or worsening infection in a PwD are more subtle and less systemic than a person without diabetes (IWGDF Practical Guidelines, 2023). Foot infection is one of the most common complications of diabetes, and represents a huge challenge in clinical practice. While it is well acknowledged that infection is a major issue, clear up-to-date guidance is needed for HCPs in the UK. The focus should be on prevention wherever possible, and identifying risk factors and red flags. A management approach is also needed that combines efficacy with awareness of antimicrobial stewardship. There is a perception among diabetic foot specialists that the majority of current infection-treatment guidelines do not address the subtleties of diabetic infections in people with diabetic foot ulcers (DFUs), which can lead to catastrophic patient outcomes faster than other wound aetiologies.

The objective of this consensus is to provide support to UK HCPs, especially those in primary care and support roles. Improved knowledge will help with prompt identification of DFIs and timely access to appropriate treatment.

The key points of this document will include clear, actionable guidance for best practice and a pathway for use in practice:

Holistic patient assessment and identifying risk factors
Red flags and prevention measures in suitable patients
Early intervention in infection
Treatment/product selection – encompassing the importance of cleansing, debridement and dressing selection where appropriate
Pathway for management
Antimicrobial stewardship.

This report aims to be a clinically useful document that lays out a practical course of action for HCPs at all levels – from unregistered care home workers to experienced diabetic foot practitioners. This consensus can help increase the confidence of frontline HCPs and workers in identifying a DFI, and confidently escalating the case to specialists as soon as possible.

Jacqui Fletcher, Chair

Download the full consensus document below

↓ Download pdf

Disclaimer: This document has been developed by Wounds UK/ The Diabetic Foot Journal and supported by Flen Health, L&R, and MESI.

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