Diabetic Foot Infections

Question 1

Risk factors for diabetic foot infections

Answer 1

-Neuropathy
-Angiopathy/ischemia
-Immunologic defects
-Poor wound healing

Question 2

Patient presentation of diabetic foot infections

Answer 2

-Typical local signs of infection +/- purulent secretions
-Discolored tissue
-Foul odor

Question 3

What cultures are recommended for diabetic foot infection?

Answer 3

-Wound cultures are not recommended for mild infection
-Bone cultures are typically obtained following incision and drainage
-Blood cultures may be considered

Question 4

Common pathogens in diabetic foot infected ulcers

Answer 4

-S. aureus
-Strep. spp.

Question 5

Common pathogens in diabetic foot chronic infected ulcers

Answer 5

-S. aureus
-Strep. spp.
-Enterobacteriaceae spp.
-Anaerobes

Question 6

Common pathogens in diabetic foot macerated ulcers due to soaking

Answer 6

-S. aureus
-Strep. spp.
-Pseudomonas

Question 7

Common pathogens in diabetic foot chronic non-healing ulcers

Answer 7

-S. aureus
-Strep. spp.
-Enterococcus spp.
-Pseudomonas
-Anaerobes

Question 8

Risk factors for MRSA in diabetic foot infections

Answer 8

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

Question 9

Risk factors for pseudomonas in diabetic foot infections

Answer 9

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

Question 10

Overall management of diabetic foot infections

Answer 10

-Surgical intervention
-Glycemic control
-Antibiotics

Question 11

First-line treatment for mild diabetic foot infections

Answer 11

-Dicloxacillin (not on market)
-Cephalexin
-Clindamycin

Question 12

Treatment for mild diabetic foot infections when the patient was recently on antibiotics

Answer 12

-Augmentin
-Levo
-Moxi

Question 13

Treatment for mild diabetic foot infections when the patient has risk factors for MRSA

Answer 13

-Bactrim
-Doxy

Question 14

Treatment duration for mild diabetic foot infections

Answer 14

1-2 weeks

Question 15

What bacteria do you need to cover when treating for mild diabetic foot infections?

Answer 15

-MSSA
-Strep. spp.

Question 16

What bacteria do you need to cover when treating for moderate diabetic foot infections?

Answer 16

-MSSA
-Strep. spp.
-Enterobacteriaceae
-Anaerobes

Question 17

First-line treatment for moderate diabetic foot infections

Answer 17

Moxi, Augmentin, Cipro/levo + clindamycin/metronidazole

Question 18

Treatment for moderate diabetic foot infections when the patient has risk factors for pseudomonas

Answer 18

Cipro/levo + clindamycin/metronidazole

Question 19

Treatment for moderate diabetic foot infections when the patient has risk factors for MRSA

Answer 19

(Add to first-line treatment)
-Doxy
-Linezolid
-Vanco
-Bactrim

Question 20

Treatment duration for moderate diabetic foot infections

Answer 20

2-3 weeks

Question 21

What bacteria do you need to cover when treating for severe diabetic foot infections?

Answer 21

-MSSA
-Strep. spp.
-Enterobacteriaceae
-Anaerobe
-Pseudomonas

Question 22

First-line treatment for severe diabetic foot infections

Answer 22

Zosyn, carbapenem, cefepime + clindamycin or metronidazole

Question 23

Treatment for severe diabetic foot infections when the patient has risk factors for MRSA

Answer 23

(Add to first-line treatment)
-Vanco
-Linezolid
-Dapto

Question 24

Treatment duration for severe diabetic foot infections

Answer 24

2-3 weeks