DFI

Question 1

DFI causative pathogens

Answer 1

Streptococcus spp.
Staphylococcus aureus
Pseudomonas aeruginosa–>due to soaking (water bug)

Question 2

Risk factors

Answer 2

Neuropathy
Angiopathy/ischemia
Immunologic defects
Poor wound healing

Question 3

MDR Risk factors

Answer 3

MRSA–>ALWAYS ADD MRSA COVERAGE IN INDIANAPOLIS

Previous MRS infection within past year
Local MRSA prevalence > 30-50%
Recent hospitalization
Failed non-MRSA antibiotics

Question 4

Pseudomonas risk factors

Answer 4

History of pseudomonas infection
Soaking feet in water
Warm climate
Severe infection
Failed non-pseudomonal antibiotics

Question 5

Presentation

Answer 5

Localized: infection signs +/- purulent secretions

Question 6

Cultures

Answer 6

Wound: not recommended for mild
Bone: after incision and drainage
Blood: considered

Question 7

Overall management

Answer 7

Surgical intervention

Glycemic control

Antibiotics

Question 8

Mild

Answer 8

Duration–>1-2 weeks

Bugs: MSSA, streptococci spp.

1st line: cephalexin or clindamycin

Recent antibiotics–> Augmentin or Levo/Moxifloxacin

MRSA risk–> Bactrim or Doxycycline

Question 9

Moderate

Answer 9

Duration–> 2-3 weeks

Bugs: MSSA, Streptococcus spp, enterobacteriaceae, anaerobes

1st line: Moxifloxacin, Augmentin OR Cipro/Levi + Clindamycin or Metronidazole

Pseudomonal risk: Cipro/Levofloxacin + Clindamycin or metronidazole

MRSA risk: doxycycline or linezolid or vancomycin or bactrim

Question 10

Severe

Answer 10

Duration–> 2-3 weeks

Bugs: MSSA, streptococci spp. Enterobacteriaceae, anaerobes, pseudomonas

1st line: Zosyn or cefepime or carbapenem + clindamycin or metronidazole

MRSA risk: vancomycin or linezolid or daptomycin