Infections precede most hospitalizations and amputations in diabetes-related foot disease, yet the relationship between infection severity, antibiotic management, and healing remains uncertain. A prospective study published in BMJ Open Diabetes Research & Care evaluated outcomes among patients presenting with a new diabetes-related foot infection (DFI), with particular focus on antibiotic exposure and ulcer healing at 6 months.

Between 2018 and 2020, 234 patients with diabetes, a foot ulcer, and a newly diagnosed DFI were enrolled across 20 hospitals in Australia and New Zealand. Infections were classified as mild or moderate/severe, with further categorization based on the presence of osteomyelitis. The primary outcome was healing of the index ulcer or amputation site at 6 months. Multivariable logistic regression models adjusted for potential confounders examined associations between healing and infection severity, duration of intravenous antibiotic therapy, and total antibiotic duration.

Among participants (mean age 61 years; 77% male), 15% had mild DFI, 31% moderate/severe without osteomyelitis, and 54% moderate/severe with osteomyelitis. Median total antibiotic duration increased across severity groups, from 18 days in mild infection to 34 days in moderate/severe infection with osteomyelitis. Healing at 6 months occurred in 73% of mild cases, 68% of moderate/severe cases without osteomyelitis, and 62% of moderate/severe cases with osteomyelitis.

After adjustment, infection severity and both intravenous and total antibiotic duration were not associated with healing at 6 months. Further work is needed to identify appropriate subgroups and endpoints for antibiotic trials in DFI.