Diagnostics of infections in diabetic foot syndrome

Background: Themicrobiological diagnostics of diabetic foot infections (DFI) are poorly defined in many publications, with limited information available regarding techniques for specimen collection, transportation to microbiological laboratories, digital ordering processes, and the specific microbiological examination methods employed. Objective: What is currently known about the microbiological diagnostics of DFI, and can recommendations be formulated based on existing knowledge? Material and methods: An analysis of the guidelines on the diagnosis and treatment of foot infection in persons with diabetes (International Working Group on the Diabetic Foot, IWGDF, Infectious Diseases Society of America, IDSA, 2023) was carried out for fundamental research, and expert recommendations. Results: In cases of DFI, diabetic foot osteomyelitis (DFO), only bone and/or tissue biopsies should be collected for microbiological examinations, with the addition of histological examinations in cases of DFO. Clear operational agreements should be established with the microbiological laboratory in all instances. This includes protocols for biopsy transportation, transit times, required clinical information, desired examinations, and timely and relevant reporting to clinical colleagues. Furthermore, it is highly likely that molecular techniques will also play an important role in the near future. Conclusion: Clear working agreements must be established with the microbiological laboratory for the analysis of biopsies that were taken for the diagnostics of DFI/DFO/DFU.