Diabetic Foot Infections

Publication Date: June 15, 2012

Key Points

Key Points

Consider the possibility of infection occurring in any foot wound in a patient with diabetes. (SR, L)
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Note: Evidence of infection generally includes classical signs of inflammation (redness, warmth, swelling, tenderness or pain) or purulent secretions, but may also include additional or secondary signs (eg, nonpurulent secretions, friable or discolored granulation tissue, undermining of wound edges, foul odor). (SR, L)
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Select and routinely use a validated classification system, such as that developed by the International Working Group on the Diabetic Foot (IWGDF)—abbreviated with the acronym PEDIS—or IDSA (Table 3), to classify infections and to help define the mix of types and severity of their cases and their outcomes. (SR, H)
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The DFI (diabetic foot infection) Wound Score (Table 4) may provide additional quantitative discrimination for research purposes. (WR, L)
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Other validated diabetic foot classification schemes have limited value for infection, as they describe only its presence or absence. (, L)
Moderate recommendation
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Assessment

Assessment

...te a diabetic patient presenting with a...


...se infection based on the presence of a...


...aware of factors that increase the risk for DFI an...


...imb and foot for arterial ischemia, (SR, M...

...s insufficiency, presence of protective sensat...


...etation of the Results of Ankle-Brachial Index Mea...


Consulta...

...th outpatients and inpatients with a DFI, p...

...oot care teams can include (or should h...

...ans without adequate training in wo...

...here is clinical or imaging evidence...

...inicians unfamiliar with pressure...

...unities with inadequate access to c...


Hospitalization

Hospitaliz...

...ll patients with a severe infection, se...


...g discharged a patient with a DFI should: (SR,...


Microbiology

...icrobiolog...

...or clinically uninfected wounds, do NOT coll...


...nfected wounds, send appropriately o...

...ultures may be unnecessary for a mild...


...lture should be from deep tissue, obtained by bi...


Imaging Studies

Imaging St...

...senting with a new DFI should have plain radiog...


...agnetic resonance imaging (MRI) is the study...


...ailable or contraindicated, consider th...


Treatment

Treatm...

...odifying an Antibiotic Regimen (See below...

...nically uninfected wounds should NOT be treated...

...rescribe antibiotics for all infected wounds...

...ns should select an empirical antibiotic regime...

...moderate infections in patients who have not re...

...e infections, start broad-spectrum empi...

...therapy directed at Pseudomonas aerugin...

...ding empiric therapy directed against methic...

...ase definitive therapy on both the results...

...he route of therapy largely on infection severi...

...ans can probably use highly bioavailable oral anti...


...inue antibiotic therapy until, but not beyond...

...ntibiotic course for a soft tissue infect...


...teomyelit...

...ider osteomyelitis as a potential com...

...erform a probe to bone (PTB) test for any DFI...

...radiographs of the foot, although t...

...onsider using serial plain radiographs t...

...diagnostic imaging test for DFO use MRI. (...

...te: MRI is not always necessary for diagnos...

...f MRI is unavailable or contraindicated,...

...other types of nuclear medicine investigat...

...st definitive way to diagnose DFO is...

...debrided to treat osteomyelitis, s...

...tients not undergoing bone debridement, con...

...ing either primarily surgical or primarily me...

...a radical resection leaves no remaining infect...

...ersistent infected or necrotic bone, p...

...lly treating DFO, IDSA does NOT curren...


...al Intervention...

...surgical clinicians should consider re...

...inicians should debride any wound that...

...al intervention is required for mos...

...lve a vascular surgeon early on to consider re...

...lthough most qualified surgeons can perform an...


...nd Care...

..., aimed at removing debris, eschar and surroun...

...te: Sharp (or surgical) methods are generally bes...

but mechanical, autolytic or larval debridement te...

...pressure off the wound to the entire weight-bear...

...essings that allow for moist wound healing and co...

...al antimicrobials are not necessar...

...skin equivalents, (WR, M)21881...

...actors, (WR, M)21881...

...nulocyte colony stimulating factors, (WR,...

...perbaric oxygen therapy, (SR,...

or negative pressure wound therapy. (WR,...


...biology of DFIs Aerobes Staphylococcus...


...SA and International Working Group...


...DFI Wound ScoreHaving trouble viewing...


...mmendations for Collection of Specimens for Cultu...


...tibiotic Selection Overview: Questions a Clin...


...ed Empirical Antibiotic Regimens Based on Clinic...


...gnostic Bone Biopsy is Most Recommend...


...ble 9. Approach to Treating a Patient wit...


...gested Route, Setting, and Duratio...


...le 11. Signs of a Possible Imminent Limb-...


...ions to Ask When Dealing with Nonresponse...


...re 1. Schematic Diagram of Cross-Section of the F...


...Approach to the Infected Diabetic F...