Epidemiology and etiology

Foot ulcers and related infections are among the most common, severe, and costly complications of diabetes mellitus. Fifteen percent of all patients with diabetes develop at least one foot ulcer, resulting in direct health care expenditures of approximately $9 billion annually in the United States.32,33

Infected diabetic foot ulcers typically contain a multitude of microorganisms. Aerobic gram-positive cocci, such as S. aureus and ft-hemolytic streptococci, are the predominant pathogens in acutely infected diabetic foot ulcers. However, chronically infected wounds are subject to polymicrobial infection. The clinician should suspect the involvement of gram-negative (Enterobacteriaceae and P. aeruginosa) and possibly low-virulence pathogens (including enterococci and S. epidermidis) in chronic or necrotic wounds. Foul-smelling, necrotic or gangrenous wounds are also commonly infected with anaerobic bacteria. Patients recently hospitalized or treated with broad-spectrum antibiotics are at risk for infection with antibiotic-resistant organisms, including MRSA and vancomycin-resistant enterococci (VRE).34

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