Diabetic Foot Infections (DFI) 
Severity Classification: ...

Diabetic Foot Infections (DFI) 

Severity Classification: 

 • Mild (superficial ulcer, no involvement of deeper structures, erythema <2 cm); 

 • Moderate (ulcer with involvement of deeper structures or erythema >2 cm); 

 • Severe (moderate + systemic signs of infx)

Initial Evaluation: Cleanse, debride, probe, culture. Check pulses/sensation, ABIs (40% will have PAD), consider XR/MRI

Diagnosis: Wound culture. Most polymicrobial w/ GPCs>GNRs, anaerobes. For mod-severe infx: add blood cx + ESR/CRP

 • Osteomyelitis: Increased risk if: grossly visible bone/probe to bone, ulcer > 2 cm2, ulcer >1-2 weeks, ESR > 70mm/h

 • If able to probe to bone, sens/spec for diabetic osteo is 87%/83%

 • If suspicious for osteo, obtain plain films ± MRI ± surgical consult for bone/tissue biopsy ± ID consult

Treatment: Definitive tx based on deep cx obtained PRIOR to the initiation of abx. Appropriate wound care is critical.

 • Mild: Oral→target GPCs (diclox, cephalexin, amox/clav, levo); use TMP-SMX or doxy for MRSA; 1-2 weeks tx

 • Moderate/Severe IV→target GPCs (vanc, linez, dapto), GNRs* (CTX, levo, Unasyn), anaerobes (Flagyl/clinda); 2-4 wks

 • *Use anti-PsA GNR (cefepime, pip/tazo) if: severe, immunocomp, neutropenia, water exposure, burn/puncture, nosocom

 • If improved, may deescalate Mod/Severe treatment to highly bioavailable PO regimen to complete course

#Diabetic #Foot #Infections #DFIs #diagnosis #management #Diabetes 
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