The optimal approaches to managing
diabetic foot infections remain a challenge for clinicians. Despite an exponential rise in publications investigating different treatment strategies, the various agents studied generally produce comparable results, and high-quality data are scarce. In this systematic review, we searched the medical literature using the PubMed and Embase databases for published studies on the treatment of
diabetic foot infections as of June 2018. This systematic review is an update of previous reviews, the first of which was undertaken in 2010 and the most recent in 2014, by the
infection committee of the International Working Group of the
Diabetic Foot. We defined the context of literature by formulating clinical questions of interest, then developing structured clinical questions (PICOs) to address these. We only included data from controlled studies of an intervention to prevent or cure a
diabetic foot infection. Two independent reviewers selected articles for inclusion and then assessed their relevant outcomes and the methodological quality. Our literature search identified a total of 15 327 articles, of which we selected 48 for full-text review; we added five more studies discovered by means other than the systematic literature search. Among these selected articles were 11 high-quality studies published in the last 4 years and two Cochrane systematic reviews. Overall, the outcomes in patients treated with the different
antibiotic regimens for both skin and
soft tissue infection and
osteomyelitis of the
diabetic foot were broadly equivalent across studies, except that treatment with
tigecycline was inferior to
ertapenem (±vancomycin). Similar outcomes were also reported in studies comparing primarily surgical and predominantly
antibiotic treatment strategies in selected patients with
diabetic foot osteomyelitis. There is insufficient high-quality evidence to assess the effect of various adjunctive
therapies, such as
negative pressure wound therapy, topical
ointments or hyperbaric
oxygen, on
infection related outcomes of the
diabetic foot. In general, the quality of more recent trial designs are better in past years, but there is still a great need for further well-designed trials to produce higher quality evidence to underpin our recommendations.