DM foot infections

Question 1

What is the presentation of Diabetic foot infections?

Answer 1

• erythema
• warmth
• swelling
• induration
• tenderness
• pain
• purulent secretions

Question 2

What pathogens are common for diabetic foot ulcer (antibiotic niave)?

Answer 2

• staphylococcus aureus
• steptococcus spp.

Question 3

What pathogens are common for diabetic foot chronic ulcer (antibiotic exposure)?

Answer 3

• staphyloccus aureus
• steptococcus spp.
• enterbacteriacae

Question 4

What pathogens are common for diabetic foot macerated ulcer due to soaking?

Answer 4

• pseudomonas aeruginosa
• aerobic gram positive

Question 5

What pathogens are common for diabetic foot chronic non-healing ulcers?

Answer 5

aerobic gram positives

Question 6

What are the adjunct treatment options for diabetic foot infections?

Answer 6

• wound care
• cultures (deep tissue following cleaning and debridement)
• glycemic control
• activity restriction

Question 7

What are the MRSA risk factors in diabetic foot infections?

Answer 7

• history of MRSA infection or colonization in past year
• prevalence of MRSA > 30-50% in local area
• recent hospitalization or antibiotic use
• ICU admission, prolonged hospitalization before start of infection, hemodialysis, nursing home, chronic IV catheter

Question 8

What are the risk factors for Pseudomonas in diabetic foot infections?

Answer 8

• soaking feet
• failed non-pseudomonal antibiotics

Question 9

What is the standard duration of therapy for diabetic foot infections?

Answer 9

1-2 weeks

Question 10

When would the duration of treatment for diabetic foot infections be increased?

Answer 10

duration increased from 1-2 week to 3-4 weeks if…
- responding slower than expected
- improving but extensive infection
- severe peripheral artery disease

Question 11

What is the duration of treatment for diabetic foot infections if there is bone involvement (osteomyelitis)?

Answer 11

6 weeks

Question 12

What is the classification of MILD infection?

Answer 12

• signs and symptoms of local infection w/ erthema > 0.5 but < 2cm around the wound
• no signs of systemic infection
• no bone involvement

Question 13

What is the classification of MODERATE infection?

Answer 13

• signs and symptoms of local infection w/ erythema > 2cm around the wound and involvement of skin structures deeper than subcutaneous
• no signs of systemic infection
• bone involvement may be present

Question 14

What is the classification of SEVERE infection?

Answer 14

• signs and symptoms of local infection
• SIRS positive (systemic infection)
• bone involvement

Question 15

What is the standard treatment for mild diabetic foot infection?

Answer 15

• dicloxacillin
• cephalexin

Question 16

What is the treatment for mild diabetic foot infection if the patient has had antibiotics in the last 30 days?

Answer 16

• amoxicillin/clavulanate
• levofloxacin or moxifloxicin
• trimethoprim/sulfamethoxazole

Question 17

What is the treatment for mild diabetic foot infection if MRSA risk factors are present?

Answer 17

• trimethoprim/sulfamethoxazole
• doxycycline
• linezolid

Question 18

What is the standard treatment for moderate/severe diabetic foot infection?

Answer 18

• IV= ampicillin/sulbactam, ceftriaxone
• PO= amoxicillin/clavulanate, cefturoxime

severe infection always recieve IV treatment initially

Question 19

What is the treatment for moderate/severe diabetic foot infection if the patient had recent antibiotic use?

Answer 19

• IV= piperacillin/tazobactam, ceftriaxone, ertapenem
• PO= cefuroxime

severe infection always recieve IV treatment initially

Question 20

What is the treatment for moderate/severe diabetic foot infection with macerated ulcers or reside in warm climates?

Answer 20

• IV= piperacillin/tazobactam, carbapenem
• PO= dicloxacillin + ciprofloxacin

Question 21

What is the treatment for mild diabetic foot infection if MRSA risk factors?

Answer 21

• IV= vancomycin, daptomycin, linezolid
• PO= linezolid, trimethoprim/sulfamethoxazole, doxycycline