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

...ssessmen...

...valuate a diabetic patient presenting with...


...ose infection based on the presence of at least...


...of factors that increase the risk for D...


...he affected limb and foot for arterial...

...sufficiency, presence of protective sensation...


...rpretation of the Results of Ankle-Brachial In...


Consultati...

...outpatients and inpatients with a DF...

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

...s without adequate training in wound debridement s...

...inical or imaging evidence of significant...

...s unfamiliar with pressure off-load...

...ties with inadequate access to consu...


Hospitalization

...ospitaliza...

...with a severe infection, selected p...


Prior to being discharged a patient with a DFI...


Microbiology

...obiology

...clinically uninfected wounds, do NOT collect a...


For infected wounds, send appropriately obt...

...ote: Cultures may be unnecessary for a mild...


...culture should be from deep tissue, ob...


Imaging Studies

Imaging Studie...

...patients presenting with a new DFI should...


...netic resonance imaging (MRI) is the...


...vailable or contraindicated, conside...


Treatment

...eatment...

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

...cally uninfected wounds should NOT be...

...e antibiotics for all infected wounds, but...

...hould select an empirical antibiotic regimen bas...

...erate infections in patients who have not r...

For most severe infections, start broad-spectrum...

...directed at Pseudomonas aeruginosa is usually u...

...onsider providing empiric therapy directe...

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

...oute of therapy largely on infection sever...

...ans can probably use highly bioavaila...


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

...itial antibiotic course for a soft...


...teomyeliti...

...er osteomyelitis as a potential complication...

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

...plain radiographs of the foot, although they h...

...sider using serial plain radiographs to diag...

...tic imaging test for DFO use MRI. (SR, M)2...

...s not always necessary for diagnosing or managin...

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

...types of nuclear medicine investigation...

...efinitive way to diagnose DFO is by the...

...hen bone is debrided to treat osteomyelitis...

...ients not undergoing bone debridement, consi...

...ing either primarily surgical or p...

...dical resection leaves no remaining infected ti...

...ersistent infected or necrotic bone, prol...

...ally treating DFO, IDSA does NOT currently supp...


Surgical Interventio...

...gical clinicians should consider requesting an...

...ould debride any wound that has nec...

...intervention is required for most foot infection...

...olve a vascular surgeon early on t...

...ost qualified surgeons can perform an u...


...ound Car...

...bridement, aimed at removing debris, eschar and s...

...Sharp (or surgical) methods are gene...

...echanical, autolytic or larval debridemen...

Redistribute pressure off the wound to the entire...

...t dressings that allow for moist wound healing an...

...opical antimicrobials are not necessary for mo...

...engineered skin equivalents, (WR,...

growth factors, (WR, M)2...

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

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

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


...2. Microbiology of DFIs Aerobe...


...A and International Working Group on the Diabet...


...nd ScoreHaving trouble viewing table? Expa...


...endations for Collection of Specimens fo...


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


...able 7. Suggested Empirical Antibi...


...8. Diagnostic Bone Biopsy is Most...


...able 9. Approach to Treating a Patient with D...


...10. Suggested Route, Setting, and Du...


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


...Questions to Ask When Dealing with Non...


...hematic Diagram of Cross-Section of the Foot...


...gure 2. Approach to the Infected Di...