Diabetic Foot Infections

Last updated April 8, 2022

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

...Assessme...

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


...ion based on the presence of at least...


...f factors that increase the risk for...


...ted limb and foot for arterial ischemi...

...insufficiency, presence of protective sensation a...


...1. Interpretation of the Results of Ankle-Brachial...


...Consultation...

...ients and inpatients with a DFI, provide a...

Diabetic foot care teams can include (or s...

...ithout adequate training in wound debridem...

...re is clinical or imaging evidence of sign...

...iliar with pressure off-loading or spec...

...nities with inadequate access to consultation fr...


Hospitalization

...Hospitalization...

...l patients with a severe infection, sele...


...or to being discharged a patient wit...


Microbiology

...Microbiolog...

...nically uninfected wounds, do NOT collect a spec...


...nfected wounds, send appropriately obtained spe...

...es may be unnecessary for a mild infection...


...cimens for culture should be from deep...


Imaging Studies

...Imagi...

...s presenting with a new DFI should have...


Magnetic resonance imaging (MRI) is the study of...


When MRI is unavailable or contrain...


Treatment

...Tr...

...Selecting and Modifying...

...nfected wounds should NOT be treated with ant...

...biotics for all infected wounds, but note t...

...s should select an empirical antibiotic regi...

...to moderate infections in patients who have not r...

...severe infections, start broad-spectrum emp...

...erapy directed at Pseudomonas aerugino...

...iding empiric therapy directed against methici...

...itive therapy on both the results of an a...

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

...nicians can probably use highly bioavail...


...ontinue antibiotic therapy until,...

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


...Osteomyelitis...

...sider osteomyelitis as a potential complic...

...rm a probe to bone (PTB) test for any...

...lain radiographs of the foot, although they have...

...ider using serial plain radiographs to diagnose...

...c imaging test for DFO use MRI. (SR,...

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

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

...No other types of nuclear medicine...

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

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

...s not undergoing bone debridement, consider obtai...

Consider using either primarily surgical...

...resection leaves no remaining infecte...

...hen there is persistent infected or...

For specifically treating DFO, IDSA d...


...l clinicians should consider requesting an assessm...

Clinicians should debride any wound tha...

...ent surgical intervention is requi...

...ascular surgeon early on to consider reva...

...ough most qualified surgeons can perform an urgen...


...Wound C...

...med at removing debris, eschar and surround...

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

...hanical, autolytic or larval debridemen...

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

...ct dressings that allow for moist wound h...

...imicrobials are not necessary for mos...

...ioengineered skin equivalents, (...

...factors, (WR, M)21881

...yte colony stimulating factors, (WR, M)2...

...rbaric oxygen therapy, (SR, M)218...

...gative pressure wound therapy. (WR,...


...biology of DFIs Aerobes Staphylo...


.... IDSA and International Working Group o...


Table 4. DFI Wound Score Item...


...ecommendations for Collection of Spec...


...ble 6. Antibiotic Selection Overview...


...gested Empirical Antibiotic Regimens Ba...


...iagnostic Bone Biopsy is Most Reco...


...ach to Treating a Patient with Dia...


...sted Route, Setting, and Duration of Antibioti...


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


...Questions to Ask When Dealing with Nonresponse o...


...ematic Diagram of Cross-Section of...


...2. Approach to the Infected Diabetic Foot...