Diabetic Foot Infections
Key Points
Key Points
Assessment
...a diabetic patient presenting with a...
...gnose infection based on the presence of...
...of factors that increase the risk f...
...ed limb and foot for arterial ischemia, (SR, M)21...
...ufficiency, presence of protective sensation and...
.... Interpretation of the Results of An...
...Consultation...
...ients and inpatients with a DFI, provide a w...
...ic foot care teams can include (or sho...
...ithout adequate training in wound debrid...
...linical or imaging evidence of signi...
...linicians unfamiliar with pressure off-loading...
...communities with inadequate access to c...
Hospitalization
...Hospitaliz...
...ients with a severe infection, sele...
...or to being discharged a patient with a...
Microbiology
...Microbiology...
...r clinically uninfected wounds, do NO...
...nfected wounds, send appropriately obtained spe...
...res may be unnecessary for a mild infection in...
...for culture should be from deep tissue,...
Imaging Studies
...Ima...
...s presenting with a new DFI should have plain ra...
...resonance imaging (MRI) is the study of ch...
...available or contraindicated, consider the comb...
Treatment
...Treatment...
...Sel...
...ly uninfected wounds should NOT be treated w...
...be antibiotics for all infected wounds, bu...
...cians should select an empirical antibiotic r...
...o moderate infections in patients who have not r...
...most severe infections, start broad-spectrum e...
...rapy directed at Pseudomonas aeruginosa is usual...
...providing empiric therapy directed agai...
...ase definitive therapy on both the results of an...
...e the route of therapy largely on infection se...
...nicians can probably use highly bioavailable or...
...ibiotic therapy until, but not beyond, res...
...nitial antibiotic course for a soft tissue...
...Osteomyelitis...
...ider osteomyelitis as a potential complic...
...rform a probe to bone (PTB) test for any DFI with...
...iographs of the foot, although they ha...
...ider using serial plain radiographs to d...
...diagnostic imaging test for DFO use MRI. (S...
...te: MRI is not always necessary for diagnosing...
...s unavailable or contraindicated, conside...
...e: No other types of nuclear medic...
...e most definitive way to diagnose DFO...
...bone is debrided to treat osteomyelitis, send a...
For patients not undergoing bone debr...
...either primarily surgical or primaril...
...cal resection leaves no remaining infected ti...
...there is persistent infected or necrotic bone,...
...ically treating DFO, IDSA does NOT current...
...linicians should consider requesting an as...
...ld debride any wound that has necrotic ti...
...t surgical intervention is required for most f...
...a vascular surgeon early on to consider reva...
...t qualified surgeons can perform an u...
...Wound...
...t, aimed at removing debris, eschar a...
...te: Sharp (or surgical) methods are generally best...
...autolytic or larval debridement techniques may be...
...stribute pressure off the wound to the entir...
...dressings that allow for moist wound healing a...
...obials are not necessary for most clinically...
...skin equivalents, (WR, M)21881...
...factors, (WR, M)21881...
...yte colony stimulating factors, (WR, M)21881...
...aric oxygen therapy, (SR, M)218...
...essure wound therapy. (WR, L)21881...
...2. Microbiology of DFIs Aerobes...
...IDSA and International Working Group on...
...FI Wound Score Item Assessment...
Table 5. Recommendations for Colle...
...Table 6. Antibiotic Selection Overvie...
...le 7. Suggested Empirical Antibiotic...
...e 8. Diagnostic Bone Biopsy is Most Recommended...
.... Approach to Treating a Patient w...
...0. Suggested Route, Setting, and Duration of...
...1. Signs of a Possible Imminent Limb-...
...ble 12. Questions to Ask When Dealing...
...e 1. Schematic Diagram of Cross-Section of the Foo...
...ach to the Infected Diabetic Foot...