{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T16:53:11Z","timestamp":1783702391969,"version":"3.55.0"},"reference-count":53,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Diabetic foot infection (DFI) includes soft tissue infection and osteomyelitis below the ankle and is a leading cause of lower limb amputation and mortality in diabetic patients. Treatment involves prolonged antibiotic therapy with surgical debridement or amputation. Local antimicrobial therapy offers an adjunct or alternative to systemic therapy. This systematic review and meta\u2010analysis assessed the efficacy of systemic antibiotic therapy compared with local and combination (local and systemic) therapy in DFI. A meta\u2010analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analysis (PRISMA) guidelines. A systematic search for studies was performed in eight sources (PROSPERO: CRD42024518421). The primary outcome was clinical cure rates, with secondary outcomes including clinical improvement, time to clinical cure, recurrence, amputation rates, and pathogen eradication. Twenty\u2010one studies with 2188 participants met the inclusion criteria, including 12 randomized controlled trials and 9 observational studies. Combination antibiotics were associated with increased clinical cure rates compared with systemic antibiotics alone (OR 2.08; 95% CI 1.30\u20133.35;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) and faster healing times (Mean \u22129.8\u2009days; 95% CI \u221215.1 to \u22124.4;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05); however, results failed to reach significance when looking at randomized studies alone. Results for local antibiotics alone were non\u2010significant for all outcomes. This meta\u2010analysis suggests that definitive conclusions about the use of local antibiotics in DFI are limited by bias and heterogeneity within included studies. Combined local and systemic antibiotic treatment may allow for direct tissue infiltration of antimicrobial therapy. However, high\u2010quality, blinded randomized controlled trials are required before routine clinical adoption.\n                  <\/jats:p>","DOI":"10.1111\/1753-0407.70201","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T10:44:11Z","timestamp":1773139451000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Local Versus Systemic Antibiotics for Diabetic Foot Infection\u2014A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-6251","authenticated-orcid":false,"given":"Anas","family":"Khan","sequence":"first","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust, Eastern Rd, Brighton and Hove  Brighton UK"},{"name":"Ashford and St. Peter's Hospitals NHS Foundation Trust  Chertsey UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7959-4096","authenticated-orcid":false,"given":"Hester","family":"Lacey","sequence":"additional","affiliation":[{"name":"Flinders University  Bedford Park South Australia Australia"},{"name":"University of Sussex  Brighton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Michels","sequence":"additional","affiliation":[{"name":"Ashford and St. Peter's Hospitals NHS Foundation Trust  Chertsey UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elahwal","sequence":"additional","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust, Eastern Rd, Brighton and Hove  Brighton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjorn","family":"Telgenkamp","sequence":"additional","affiliation":[{"name":"University Hospitals Sussex NHS Foundation Trust, Eastern Rd, Brighton and Hove  Brighton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"NICE \u201cDiabetic Foot Infections Antibacterial Therapy | Treatment Summaries \u201dhttps:\/\/bnf.nice.org.uk\/treatment\u2010summaries\/diabetic\u2010foot\u2010infections\u2010antibacterial\u2010therapy\/."},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2021.01.017"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12010124"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902\u2010018\u20100327\u20102"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15228"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis346"},{"key":"e_1_2_14_8_1","unstructured":"B. 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