11 It has also increased the length of hospital stay and cost of treatment, and caused additional morbidity and mortality. 9 Increasing involvement of multidrug-resistant organisms (organisms resistant to at least three different antimicrobial classes) 10 in diabetic patients with infected foot ulcers has significantly reduced antibiotic treatment options, thus posing a serious challenge particularly in resource-constrained low- and middle-income countries where access to antimicrobial drugs is of grave concern. 8 The emergence and current global threat of antimicrobial resistance in the face of dwindling antibiotics in the development pipeline has added a new twist to the burden of IDFU. Advanced IDFUs with features of sepsis at admission usually harbour anaerobic pathogens. Wide varieties of organisms, including anaerobic bacteria, have been implicated in the aetiology of IDFU depending on the severity of infection and time from onset to presentation at healthcare facilities. 6 More than 1 million diabetic patients may require limb amputation worldwide yearly, and a greater percentage of them are in developing countries. 5 Patients with IDFU have 15–46 times higher risk of limb amputation than those with non-diabetic related ulcers.

4 The foot infection can progress to irreversible septic gangrene which often necessitates life-saving amputation of the lower limb. 3 Between 25% and 60% of diabetic patients with a background foot ulcer will develop IDFU which remains a major reason for non-traumatic amputation of the lower limbs. 2 Foot infections are more common and lethal in Africa than elsewhere globally. At 7.2% (95% confidence interval : 5.1–9.3%) and higher than the global prevalence of 6.3% (95% CI: 5.4–7.3%), Africa has the second highest global prevalence of DFU, a precursor of IDFU. Infection impairs the healing process and aggravates the condition of patients with diabetic foot ulcer (DFU) and could lead to great disability, septicaemia and death if not promptly and properly managed. 1 Ulceration often precedes foot infection in diabetic patients, with peripheral vascular disease, peripheral neuropathy and visual impairment and immunological disturbances also playing contributory roles. Infected diabetic foot ulcer is one of the most common diabetes-related infections in clinical practice, and a common indication for hospital admission. 1 It is a major global public health issue with a substantial medical, socio-economic and psychological burden. Infected diabetic foot ulcer (IDFU) is associated with inlammation or purulence occurring in sites below the ankle in persons with diabetes mellitus.

Proteus 8.7 french language pack