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...

...iabetic patient presenting with a...


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


...tors that increase the risk for DF...


...limb and foot for arterial ischemia, (SR, M)21...

...sufficiency, presence of protectiv...


...able 1. Interpretation of the Results of Ankle-Br...


Consultati...

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

...re teams can include (or should hav...

...ut adequate training in wound debridement s...

...clinical or imaging evidence of signifi...

...unfamiliar with pressure off-loading or special...

...munities with inadequate access to consultation f...


Hospitalization

...pitalization...

...ents with a severe infection, selected patients...


...r to being discharged a patient with a D...


Microbiology

...robiology...

...linically uninfected wounds, do NOT collec...


...or infected wounds, send appropriately obtai...

Note: Cultures may be unnecessary f...


...imens for culture should be from deep ti...


Imaging Studies

...ging Studies...

...l patients presenting with a new DFI...


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


...ailable or contraindicated, consider the co...


Treatment

...atment

...odifying an Antibiotic Regimen (See b...

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

...otics for all infected wounds, but...

...should select an empirical antibiotic regimen...

...or mild to moderate infections in patients who...

...evere infections, start broad-spectrum empiric...

...ric therapy directed at Pseudomonas ae...

...viding empiric therapy directed against...

...therapy on both the results of an appro...

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

Clinicians can probably use highly bioavailable or...


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

...initial antibiotic course for a s...


...teomyelit...

...nsider osteomyelitis as a potential complic...

...form a probe to bone (PTB) test for...

Obtain plain radiographs of the foot, although th...

...: Consider using serial plain radiographs to d...

...a diagnostic imaging test for DFO use MRI. (SR, M...

...not always necessary for diagnosing or manag...

...MRI is unavailable or contraindic...

...ther types of nuclear medicine inves...

...initive way to diagnose DFO is by th...

...s debrided to treat osteomyelitis, send a...

For patients not undergoing bone debridement...

...nsider using either primarily surgica...

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

...persistent infected or necrotic bone, p...

...fically treating DFO, IDSA does NOT curre...


...gical Intervent...

...cal clinicians should consider reque...

...linicians should debride any wound that has ne...

...cal intervention is required for most foot...

...scular surgeon early on to consider r...

...gh most qualified surgeons can perform...


...nd Care

...ment, aimed at removing debris, eschar and surroun...

...or surgical) methods are generally best, (SR, L)2...

...ut mechanical, autolytic or larval debridement tec...

...tribute pressure off the wound to the entire we...

...ngs that allow for moist wound healing and...

...opical antimicrobials are not necessary for most...

...gineered skin equivalents, (WR,...

...wth factors, (WR, M)218...

...nulocyte colony stimulating factors,...

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

...egative pressure wound therapy. (WR, L...


...iology of DFIs Aerobes S...


...and International Working Group on the Diabetic...


...Wound ScoreHaving trouble viewing table?...


...le 5. Recommendations for Collection of Specim...


...Antibiotic Selection Overview: Question...


...ble 7. Suggested Empirical Antibiotic Regimens B...


...ostic Bone Biopsy is Most Recommended When:...


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


...ble 10. Suggested Route, Setting, an...


...11. Signs of a Possible Imminent Limb-Thre...


...stions to Ask When Dealing with Nonres...


...Schematic Diagram of Cross-Section o...


...pproach to the Infected Diabetic F...