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

...sessment

...a diabetic patient presenting with a f...


...agnose infection based on the presence of at leas...


...are of factors that increase the risk for DF...


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

...ency, presence of protective sensation...


...ble 1. Interpretation of the Results of Ankle-Brac...


...onsultation...

...ents and inpatients with a DFI, provide a well-...

...ic foot care teams can include (or should have...

...ithout adequate training in wound debridement...

...linical or imaging evidence of significant isc...

...ans unfamiliar with pressure off-loading or spe...

...with inadequate access to consultatio...


Hospitalization

...spitalization

...ith a severe infection, selected patients w...


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


Microbiology

...obiology

...y uninfected wounds, do NOT collect...


...cted wounds, send appropriately ob...

...ltures may be unnecessary for a mi...


...r culture should be from deep tissue, obtained...


Imaging Studies

Imaging Stud...

...tients presenting with a new DFI shou...


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


...I is unavailable or contraindicated, consider...


Treatment

...eatmen...

...difying an Antibiotic Regimen (See below for reco...

...infected wounds should NOT be treated w...

...ntibiotics for all infected wounds, but note that...

...d select an empirical antibiotic regimen based on...

...r mild to moderate infections in patients who h...

...or most severe infections, start broad-spe...

Empiric therapy directed at Pseudomonas aeruginos...

...r providing empiric therapy directed against me...

...efinitive therapy on both the results of...

...of therapy largely on infection severity â...

Clinicians can probably use highly bioavailable...


...inue antibiotic therapy until, but no...

...ial antibiotic course for a soft tissue...


...omyelitis

...osteomyelitis as a potential complication...

...probe to bone (PTB) test for any DFI wi...

...radiographs of the foot, although they hav...

...ote: Consider using serial plain radiographs to di...

...imaging test for DFO use MRI. (SR, M)21881...

...MRI is not always necessary for diagnosing or man...

...is unavailable or contraindicated, consider a leuk...

...: No other types of nuclear medicine invest...

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

...brided to treat osteomyelitis, send a sample...

...patients not undergoing bone debridement,...

...er using either primarily surgical or...

...radical resection leaves no remaining i...

...n there is persistent infected or necrotic bone, p...

For specifically treating DFO, IDSA d...


...gical Intervention...

...icians should consider requesting an assess...

Clinicians should debride any wound that has necro...

...rgent surgical intervention is requir...

...lar surgeon early on to consider revasculariz...

...ough most qualified surgeons can pe...


...und Care

..., aimed at removing debris, eschar...

...ote: Sharp (or surgical) methods are ge...

...echanical, autolytic or larval debridement...

...pressure off the wound to the enti...

...elect dressings that allow for moist w...

...obials are not necessary for most clinically...

...ioengineered skin equivalents, (W...

...th factors, (WR, M)21881...

...yte colony stimulating factors, (WR, M)21881...

...oxygen therapy, (SR, M)21881...

...ive pressure wound therapy. (WR, L)21881...


...ble 2. Microbiology of DFIs Aerobes...


...able 3. IDSA and International Working Group o...


...able 4. DFI Wound ScoreHaving trouble viewing t...


...Recommendations for Collection of Specimens for C...


...ntibiotic Selection Overview: Quest...


...gested Empirical Antibiotic Regimens Base...


...e 8. Diagnostic Bone Biopsy is Most Recommende...


...Approach to Treating a Patient with Diabetic Foo...


...Suggested Route, Setting, and Dura...


...Signs of a Possible Imminent Limb-Threatenin...


...le 12. Questions to Ask When Dealing with...


...Schematic Diagram of Cross-Sectio...


...roach to the Infected Diabetic Foot...