Diabetic Foot Infections
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17 terms
Terms | Definitions |
|---|---|
 Types of diabetic foot infections | Cellulitis without an open skin wound Infected ulcer and antibiotic naive Infected ulcer that is chronic or was previously treated with antibiotic therapy Ulcer that is macerated because of soaking Long duration nonhealing wounds with prolonged broad-spectrum antibiotic therapy Malodorous "Fetid Foot" with extensive necrosis or gangrene |
| Cellulitis without an open skin wound | Caused by: Beta-hemolytic streptococci & Staph aureus Treatment: Clindamycin (IV or PO), vancomycin |
| Most common diabetic foot infection | Infected ulcer with or without surrounding soft tissue infection |
| Peripheral Neuropathy | Sensory (mechanoreceptors, thermoreceptors, nocioceptors, propioceptors) Motor Autonomic |
| ACR Appropriateness Diagnosis Criteria | Use Xray, MRI with contrast, MRI without contrast |
| Cultures and infection | Do not "swab" under ulcer or wound unless previous therapy failed. Preferred culture methods are -Aspiration -Curettage -Biopsy Blood cultures usually provide low yield |
| Microbiology in diabetic foot | Staphylococcus aureus Beta-hemolytic streptococci Enterobacteriacea Pseudomonas aeruginosa Enterococci Obligate anaerobes Fungi |
| Treatment | Antimicrobial Therapy Control of hyperglycemia "Off-Loading" Wound Care Surgical Intervention |
| Adjunct Therapies | Filgrastim (C-CSF)- neutrophil stimulating HBO (Hyperbaric oxygen) Wound Vacuum-drainage systems Maggots Skin substitutes Antibiotic dressings |
| Antimicrobial Therapy diabetic foot (MRSA therapy) | MRSA coverage a must Clindamycin Vancomycin Linezolid Daptomycin |
| Abx (Gram negative bacilli coverage) | Ceftriaxone Piperacillin-tazobactam (also for anaerobic) Ertapenam (also for anaerobic) Imipenem-cilastatin (also anaerobic) Aztreonam Ciprofloxacin Moxifloxacin |
| Abx (Anaerobic) | Clindamycin Piperacillin-tazobactam Ertapenem Imipenem-cilastatin Metronidazole |
| Broad spectrum combos | Clindamycin or Vanco + Piperacillin-tazobactam or Ertapenem Vancomycin + imipenem-cilastatin Clindamycin + Ceftriaxone Clindamycin + Ciprofloxacin or Moxifloxacin Clindamycin + Cipro or Moxifloxacin |
| Which patient's are treated? | Patient with infected ulcer, "strong suspicion," and: 1. Bone visible OR 2. Probe (+) OR 3. Radiograph (+) OR 4. MRI (+) |
| Treatment of osteomyelitis and diabetic foot | Surgical procedures -Debridement of Infected Bone -Transmetatarsal Amputation -BKA (below knee amputation) -AKA |
| Treatment of Osteomyelitis | No surgery: Clindamycin + Cipro or Moxi + Rifampin (IV or PO) Post surgery mop up: any combo previously mentioned above |
| Duration of therapy | Soft tissue only: 2 to 4 weeks Gangrene or osteomyelitis present: -Surgery with no residual infection- 2 to 5 days -Surgery with residual soft tissue inx- 2 to 4 weeks -Surgery with residual (but viable) infected bone-4 to 6 weeks -No surgery or residual dead bone postoperatively- 3 months |
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