Resistant Infections in the Diabetic Foot: A Frightening Scenario

In a world where both the prevalence of diabetes and resistance to antibacterial drugs are rapidly increasing, the emerging diabetic foot infection (DFI), which is caused by resistant and multi-resistant strains, is considered an emergency situation both from a clinical and from an organizative point of view. Both gram-positive and gram-negative strains show an increasing incidence of antibiotic resistance and both the morbidity and mortality of patients with DFI sustained by resistant strains are significantly higher than those of non-resistant DFIs. Besides well-known resistance to penicillin in gram-positive cocci, the new form of enzymatic resistance in gram-negative rods: extended-spectrum beta lactamases, ampicillinase-C and carbapenemase production, not to forget multi-drug resistance, are all creating a new and frightening scenario in DFI, to which only a paradigm shift in treatment strategies, like the atibacterial therapy stewardship programs, may give positive answers in the near future. © 2018 S. Karger AG, Basel.