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Principles and practice of antibiotic stewardship in the management of diabetic foot infections

Uçkay, Ilkera,b; Berli, Martinb; Sendi, Parhamc,d; Lipsky, Benjamin A.e,f

Current Opinion in Infectious Diseases: April 2019 - Volume 32 - Issue 2 - p 95–101
doi: 10.1097/QCO.0000000000000530

Purpose of review Systemic antibiotic therapy in persons with a diabetic foot infection (DFI) is frequent, increasing the risk of promoting resistance to common pathogens. Applying principles of antibiotic stewardship may help avoid this problem.

Recent findings We performed a systematic review of the literature, especially seeking recently published studies, for data on the role and value of antibiotic stewardship (especially reducing the spectrum and duration of antibiotic therapy) in community and hospital populations of persons with a DFI.

Summary We found very few publications specifically concerning antibiotic stewardship in persons with a DFI. The case-mix of these patients is substantial and infection plays only one part among several chronic problems. As with other types of infections, attempting to prevent infections and avoiding or reducing the spectrum and duration of antibiotic therapy are perhaps the best ways to reduce antibiotic prescribing in the DFI population. The field is complex and necessitates knowledge over the current scientific literature and clinical experience. On a larger scale, clinical pathways, guidelines, and recommendations are additionally supportive.


bOrthopaedic Department, Balgrist University Hospital, Zurich

cDepartment of Infectious Diseases and Hospital Epidemiology

dDepartment of Orthopaedics and Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland

eUniversity of Washington, Seattle, USA

fGreen Templeton College, University of Oxford, Oxford, UK

Correspondence to Ilker Uçkay, MD, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland. Tel: +41 44 386 1111; fax: +41 44 386 3709; e-mail:

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