Diabetic Foot Infections: A Toolkit for Wound Care Clinicians.

Diabetic foot infections (DFIs) are a serious complication of diabetes associated with high rates of hospital admission, amputation, and early death, particularly in resource-limited communities.

• DFIs are identified as leading to high rates of hospital admission, amputation, and early death
• Persons living in resource-limited communities are identified as particularly vulnerable to poor outcomes
• The paper specifically highlights health equity aspects including barriers faced by patients from racialized backgrounds

The 2024 International Working Group on the Diabetic Foot (IWGDF) guidelines provide well-laid-out strategies for managing DFIs but tend to be better suited for use in well-resourced centers.

• The updated IWGDF guidelines were published in 2024
• The guidelines are characterized as not optimally adapted for community and resource-limited settings
• This review was designed specifically to bridge the gap between guideline recommendations and real-world application in resource-limited contexts

The review provides guidance on recognizing and diagnosing DFI, including distinguishing soft tissue infection from bone infection and noninfectious entities using clinical, laboratory, and imaging approaches.

• Imaging modalities are discussed as part of the diagnostic approach
• Distinguishing soft tissue infection from osteomyelitis (bone infection) is identified as a key diagnostic challenge
• Noninfectious entities are noted as important differential diagnoses
• Both clinical and laboratory findings are emphasized for accurate diagnosis of DFIs and diabetic foot osteomyelitis

The review details antibiotic management strategies for DFIs, including specific considerations and adaptations for resource-limited settings.

• Antibiotic considerations and approaches are detailed as a core component of DFI management
• Adapted strategies are provided specifically for resource-limited settings
• Indications for other interventions or surgical referral are also addressed
• Practical clinical cases are used to illustrate how care may be adapted based on context

Health equity aspects of DFI management are explicitly considered, with identification of barriers faced by patients from racialized backgrounds in resource-limited settings.

• The review identifies specific barriers that may be faced by patients who are from racialized backgrounds
• Resource-limited community settings are highlighted as a context requiring tailored management approaches
• Health equity is framed as an integral component of a pragmatic approach to DFI management
• The review aims to equip frontline wound clinicians with approaches grounded in up-to-date evidence framed in a real-world context