Diabetic Foot Infection – VASP¶
Evaluation¶
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Plain radiograph for all pts; MRI w/contrast if abscess/osteo suspected
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BCx (prior to antibiotics) if systemic signs of infection, or severe infection
- Do not culture swabs of lesions, as these generally only grow colonizing organisms.
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Consult podiatry if osteomyelitis present for bone specimen culture and pathology (either from debridement specimen or bone biopsy) prior to starting antibiotics.
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Consult surgery if concern for abscess, gas in tissue, joint involvement
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Assess peripheral vasculature, consider arterial flow studies/vascular surgery consult
Management¶
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Assess Severity:
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Mild: Local infxn, skin/subQ tissue only, erythema >0.5 cm but ≤2cm from ulcer
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Moderate: Local infxn w/erythema > 2 cm from ulcer or deeper structures included without SIRS
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Severe: Local infxn with systemic inflammation as evidenced by >2 SIRS criteria
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Consider anti-pseudomonal coverage if at risk for Pseudomonas infection (e.g. wet; failure of prior antibiotic therapy; chronic wound).
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Consider anaerobic coverage with metronidazole if foul-smelling and/or necrotic.
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|---|---|---|
| Mild | Cephalexin 500 QID OR Amoxicillin-clavulanate 875/125 BID |
TMP-SMX DS 1-2 tabs BID OR Doxycycline 100 BID |
| Moderate | Amoxicillin-clavulanate 875/125 BID OR Ampicillin-sulbactam 3g q6h OR Piperacillin-tazobactam 3.375g q8h ext infusion OR Levofloxacin 500 daily |
TMP-SMX DS 1-2 tabs BID + cephalexin 500 QID OR Amoxicillin-clavulanate 875/125 BID Vancomycin 15-20mg/kg q8-12h + ampicillin-sulbactam 3g q6h (anaerobic, but NO Pseudomonas cvg) OR cefepime 2g q8h (Pseudomonas cvg) + metronidazole 500 q8h (anaerobic cvg) |
| Severe | Vancomycin 15-20 mg/kg q8-12h + cefepime 2g q8h + metronidazole 500 q8h | |
Additional Information¶
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If pt HDS, hold abx until deep tissue/operative cultures obtained.
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Most diabetic foot infections are polymicrobial in nature.
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Culture results may guide therapy, but all pathogens identified may not require treatment.