ILE XI Diabetic Foot Infection Objectives

Deep Abscesses

What type of diabetic foot infection involves the central plantar space (arch) and are typically caused by minor penetrating trauma or an extension of infection of a nail or web space of toes?

Dorsum Cellulitis

What type of diabetic foot infection arises from infections in the toes that are related to routine care of the nails, nail beds, and calluses of the toes?

Mal perforans ulcers

What type of diabetic foot infection is a chronic ulcer of the sole of the foot that develops due to neuropathic changes, which are responsible for misalignment of weight-bearing bones?

Osteomyelitis

What infection nis one of the most serious complications of diabetic foot infections?

Polymicrobial

What type of DFI is more common in hospitalized patients?

Swelling, Edema

Although patients do not typically experience pain, what symptoms are most common with DFI?

Anaerobic

What type of organisms are most likely with patients presenting with foul-smell odor associated with the infection site?

Decreased sensory perception

What neuropathic change is associated with an absence of pain and unawareness of minor injuries and ulceration?

Sympathetic Nerves

What neuropathic change may be damaged, resulting in an absence of sweating and lead to cracked skin and secondary infections?

Atherosclerosis

What factor in the pathogenesis of diabetic foot infection is more common in younger patients and has rapid progression in diabetic patients compared to patients without diabetes?

Ischemia

What factor of the pathogenesis of diabetic foot infection can result from micro- and macroangiopathy and cause skin breakdown and infection?

Phagocytosis

In addition to impaired intracellular microbicidal function, what immune function may be impaired in diabetic patients due to angiopathy and low tissue oxygen levels and, therefore, contribute to diabetic foot infection?

2-3 times daily

How often should wounds be kept clean and dressing changed in a patient being treated for diabetic foot infection?

Amputation

What intervention may be required for patients with severe diabetic foot infections?

Staph and Strep

What two microorganisms are most common in DFI?

Obligate anaerobes

What microorganisms are most likely in patients with severe DFI with chronic foot ischemia?

Broad-Spectrum

What type of empiric therapy is recommended for DFI treatment, unless the infection is life- or limb-threatening and assuming that adequate wound care is also performed?

Bed Rest, Glycemic Control

What two patient management strategies are recommended in order to ensure optimal wound healing in patients treated for DFI?

1-2 weeks

What treatment duration is typically recommended for patients with mild DFI?

2-4 weeks

What treatment duration may be recommended for patients with severe DFI?

6-12 weeks

What treatment duration is recommended for patients with DFI and underlying osteomyelitis?

Mild

How is DFI described when it is a local infection involving only skin and subcutaneous tissue, without involvement of deeper tissues, no SIRS criteria, and 0.5 to 2 cm of erythema around the ulcer?

SIRS criteria

What symptom criteria indicates a severe DFI?

Mild

In what DFI severity is a patient treated with levofloxacin, moxifloxacin, or amoxicillin/clav when the patient has been treated with antibiotics within the past month?

Dicloxacillin, Clindamycin, Cephalexin

What three antibiotics are appropriate for mild DFI in patients that have NOT been treated with antibiotics in the past month?

Doxycycline, Linezolid

What medication options are recommended for patients with non-extensive/chronic wounds in order to cover for MRSA?

Vancomycin, Linezolid, Daptomycin

What medication options are recommended for patients with extensive/chronic wounds in order to cover for MRSA?

SCr, C&S

What two labs should be initially taken for treatment of DFI?