Diabetic Foot Infections
Key Points
Key Points
Assessment
Assessm...
...a diabetic patient presenting with a foot wound a...
...fection based on the presence of at least...
...actors that increase the risk for DFI and es...
...ted limb and foot for arterial isch...
...ciency, presence of protective sensation a...
...e 1. Interpretation of the Results of Ankle-Brac...
...sultation...
...r both outpatients and inpatients with a DFI, pro...
...care teams can include (or should hav...
...out adequate training in wound debri...
...is clinical or imaging evidence o...
...nfamiliar with pressure off-loading or s...
...communities with inadequate access t...
Hospitalization
...talization...
...with a severe infection, selected patie...
...ior to being discharged a patient with a DF...
Microbiology
...crobiology...
...cally uninfected wounds, do NOT coll...
...wounds, send appropriately obtained...
...res may be unnecessary for a mild infection in a...
...ulture should be from deep tissue, ob...
Imaging Studies
...aging Studies...
...tients presenting with a new DFI should...
...etic resonance imaging (MRI) is the study of choi...
...unavailable or contraindicated, cons...
Treatment
...eatment
...Modifying an Antibiotic Regimen (See...
...ninfected wounds should NOT be treat...
...otics for all infected wounds, but note...
...uld select an empirical antibiotic regimen based...
...rate infections in patients who have not recentl...
...infections, start broad-spectrum empiric ant...
Empiric therapy directed at Pseudomonas aerug...
...ng empiric therapy directed against meth...
...definitive therapy on both the results of a...
...e of therapy largely on infection seve...
...inicians can probably use highly bioavailable ora...
...antibiotic therapy until, but not beyond, resolut...
...antibiotic course for a soft tissue infect...
...eomyelitis...
...osteomyelitis as a potential complication of a...
...probe to bone (PTB) test for any DFI with...
...btain plain radiographs of the foot, altho...
...sider using serial plain radiographs to di...
...gnostic imaging test for DFO use MR...
...ote: MRI is not always necessary for...
...MRI is unavailable or contraindicated, c...
...: No other types of nuclear medici...
...he most definitive way to diagnose DFO is by t...
When bone is debrided to treat osteomyelitis,...
...not undergoing bone debridement, consider obtainin...
...ing either primarily surgical or primarily me...
...l resection leaves no remaining infected tissue, p...
...persistent infected or necrotic bon...
...ically treating DFO, IDSA does NOT currently suppo...
...al Intervention
...al clinicians should consider requesting...
...nicians should debride any wound that h...
...intervention is required for most foot infec...
...lar surgeon early on to consider revascularizat...
...qualified surgeons can perform an urgent...
...und Care
...aimed at removing debris, eschar and su...
...: Sharp (or surgical) methods are generally best,...
...echanical, autolytic or larval debrid...
...ute pressure off the wound to the entire we...
...ngs that allow for moist wound heali...
...al antimicrobials are not necessary for...
...engineered skin equivalents, (WR, M)21881...
...ctors, (WR, M)21881
...colony stimulating factors, (WR, M)21881...
...perbaric oxygen therapy, (SR, M)21...
...gative pressure wound therapy. (WR, L)2...
...Microbiology of DFIs Aerobes Staphylo...
...le 3. IDSA and International Working Group...
...ble 4. DFI Wound ScoreHaving troub...
...mmendations for Collection of Specimens for Cultu...
...6. Antibiotic Selection Overview: Qu...
...Suggested Empirical Antibiotic Regimens Based on...
...ostic Bone Biopsy is Most Recommended...
Table 9. Approach to Treating a Patie...
...le 10. Suggested Route, Setting, and Duration of A...
.... Signs of a Possible Imminent Limb-Threateni...
...12. Questions to Ask When Dealing with Non...
.... Schematic Diagram of Cross-Section of the Foot...
Figure 2. Approach to the Infected Diab...