Multidisciplinary approach recommended for wounds

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Poor treatment of infected foot wounds in people with diabetes can lead to lower extremity amputation, and about 50% of patients who have foot amputations die within five years — a mortality rate that's worse than most cancers. But about half of lower extremity amputations that aren't caused by trauma can be prevented through proper care of foot infections, note the new IDSA diabetic foot infections guidelines, which appear in Clinical Infectious Diseases.

Nearly 80% of all nontraumatic amputations occur in people with diabetes — and 85% of those begin with a foot ulcer. 

“Lower extremity amputation takes a terrible toll on the diabetic patient,” said Benjamin A. Lipsky, M.D., lead author of the guidelines and professor of medicine at the University of Washington and VA Puget Sound, Seattle. Patients often can no longer walk and are at significant risk for a second amputation and related depression, he said. 

The guidelines emphasize rapid and appropriate therapy for treating infected wounds on the feet, typically including surgical removal of dead tissue, appropriate antibiotic therapy and, if necessary, removing pressure on the wound and improving blood flow to the area. Many patients with foot infections initially receive only antibiotic therapy, which is often insufficient in the absence of proper wound care and surgical interventions, the guidelines note. 

The guidelines include 10 questions with evidence-based answers for providers. n