diabetic foot infections

Question 1

define diabetic food 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

• local swelling or induration (thicken/hard)
• erythema
• local tender or pain
• local warmth
• purulent discharge

Question 3

what is induration

Answer 3

thickening/hardening of skin

Question 4

you need to refer immediately to acute services and inform MDT foot care service if sa 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

severity is classed as

Answer 5

mild = local infection 0.5cm-<2cm erythema

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

severe = local infection hit signs of systemic inflammatory response

Question 6

when do you take samples in relation to treatment

Answer 6

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

Question 7

mild diabetic food infection, oral 1st line

Answer 7

flucloxacillin 500mg-1g QDS for 7 days then review
alternatives if penicillin allergic or unsuitable: 7 days of clarith, doxy, erythromycin (preg)

Question 8

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 8

500mg QDS for 7 days then review

Question 9

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 9

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

Question 10

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 10

500mg BD for 7 days then review

Question 11

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 11

min 7 days
up to 6 weeks for osteomyelitis

Question 12

what is osteomyelitis

Answer 12

inflammation of bone usually due to infection

Question 13

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

Answer 13

48h

Question 14

oral or IV 1st line (3 options) for pt with moderate or severe infection

+ alternative in penicillin allergy

Answer 14

• fluclox with or without IV gentamicin and/or metronidazole
• coamoxiclav with or without IV gentamicin
• IV ceftriaxone with metronidazole

allergy: cotrimoxazole (unlicensed) with or without IV gentamicin and/or metronidazole

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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