DIABETIC FOOT INFECTION

Question 1

What is a diabetic foot infection?

Answer 1

any type of skin, soft tissue or bone infection below ankle in pt with diabetes

Question 2

Defined clinically by the presence of at least two of the following (5)

Answer 2

purulent discharge
Local TDRC
Induration

Question 3

What is induration

Answer 3

thickening/hardening of skin

Question 4

Refer immediately to acute services and inform MDT foot care service if pt has a limb threatening or life threatening problem e.g.

Answer 4

ulceration with fever
any signs of sepsis
ulceration with limb ischaemia
gangrene

Question 5

Mild infection

Answer 5

local infection
0.5cm-<2cm
erythema

Question 6

Moderate infection

Answer 6

local infection
>2cm
erythema
involving deeper structures e.g. assess, osteomyelitis, septic arthritis, fasciitis

Question 7

Severe infection

Answer 7

local infection hit signs of systemic inflammatory response

Question 8

When do you take samples in relation to treatment?

Answer 8

Sample should be taken for microbiological testing before or as close as possible to the start of abx treatment

Question 9

Treatment: mild infection
1st line

Answer 9

Flucloxacillin 500mg-1g QDS for 7 days then review

Penicillin allergy:
Clarithromycin / Erythromycin (pregnancy) / Doxycycline

Question 10

erythromycin can be used if 1st line oral fluclox is unsuitable or if pt is allergic or pt is pregnant. what is the dose for mild diabetic food infection

Answer 10

500mg QDS for 7 days then review

Question 11

doxycycline can be used if 1st line oral fluclox is unsuitable or pt is allergic. what is the dose for mild diabetic foot infection

Answer 11

initially 200mg for one dose
maintenance 100mg once daily
total 7 days
then review
increase if necessary to 200mg once daily

Question 12

clarithromycin can be used for mild diabetic foot infection if 1st line oral fluclox 1g-500mg QDS 7 days then review is inappropriate/pt allergic . what is the dose

Answer 12

500mg BD for 7 days then review

Question 13

for moderate or severe infection the treatment duration is based on clinical assessment. it is for a minimum of ….. and up to …… for osteomyelitis

Answer 13

min 7 days
up to 6 weeks for osteomyelitis

Question 14

what is osteomyelitis

Answer 14

A
inflammation of bone usually due to infection

Question 15

Treatment: moderate/severe (abscess, osteomyelitis)

Answer 15

1. Flucloxacillin +/ - IV Gentamicin and/or metronidazole

Co-amoxiclav +/- IV gentamicin

IV ceftriaxone with metronidazole

2. Penicillin Allergy:
   Co-trimoxazole +/ - IV Gentamicin and/or metronidazole

Question 16

in severe infection, IV abx need to be given for at least …… until stabilised

Answer 16

48h

Question 17

Abx choices for moderate to severe diabetic food infection if psueodomonas aeruginosa suspected or confirmed

Answer 17

IV piperacillin with tazobactam
or
clindamycin with ciprofloxacin and/or IV gentamicin

Question 18

If MRSA is suspected or confirmed, which abx would you add to treatment (3)

Answer 18

IV vancomycin
IV teicoplanin
linezolid - specialist use only if the above two cannot be usd