DFI

Question 1

Risk factors

Answer 1

Neuropathy
Angiopathy/ ischemia
Immunologic defects
Poor wound healing

Question 2

Diagnosis criteria
Patient presentation and cultures

Answer 2

Presentation
- typical local sings of infection, +/- purulent secretion
-discolored tissue, foul odor

Cultures
- bone cultures: typically after I&D
- Blood cultures: may be considered
- Wound cultures not recommended for mild infection

Question 3

Causitive pathogens for infected ulcers, chronic infected ulcers, macerated ulcers due to soaking, and chronic non-healing ulcers

Answer 3

infected ulcers
- S. aureus
- streptococci spp.

chronic infected ulcers
-Enterobacteriaceae spp.
-Anaerobes
- S. aureus
- streptococci spp.

macerated ulcers due to soaking
- p. Aerogenes
- S. aureus
- streptococci spp.

chronic non-healing ulcers
- enterococcus spp.
- anaerobes
- p. Aerogenes
- S. aureus
- streptococci spp.

Question 4

Psuedomonas risk factors

Answer 4

History of pseudomonas infection
soaking feet in water
warm climate
severe infection
failed non-pseudomonal antibiotics

Question 5

Treatment and duration for Mild DFI

Answer 5

Want to cover MSSA and Strep
Duration 1-2 weeks
First line
- Dicloxacillin, cephalexin,, clindamycin

Recent antibiotic use?
SWITCH to
- augmentin
- levo or moxi

MRSA risk factors?
- Switch to
-SMX/TMP
- Doxycycline

Question 6

Treatment and duration for Moderate DFI

Answer 6

Want to cover MSSA, Strep, Enterobacteriaceae, and anaerobes
Duration 2-3 weeks
First line
- moxifloxacin
- augmentin
- cipro/levo + Clindamycin OR metronidazole

Pseudomonal risk factors?
SWITCH to
- Cipro/levo + clindamycin or Metronidazole

MRSA risk factors?
ADD
- Doxycycline
- linezolid
- vancomycin
- SMX/TMP

Question 7

Treatment and duration for severe DFI

Answer 7

want to cover MSSA, Streptococci, Enterobacteriacea, anaerobes, pseudomonas
Duration 2-3 weeks
First line
Pipericillin/tazobactam
carbapenems (NOT ERAPENEM)
Cefepime + clindamycin OR metronidazole

MRSA risk factor?
ADD
Vancomycin
Linezolid
Daptomycin