Approach to the Infected Diabetic Foot
Diabetic patient with a suspected foot infection without osteomyelitis
• Assess neurological and vascular status of
foot
• Assess for purulence or signs of
inflammation
• Assess any medical comorbidities
• Assess patient's psycho-social situation
• Consider obtaining plain radiographs
(or MRI)
• Obtain appropriate specimen(s) for culture
if clinically infected
• Obtain other appropriate laboratory tests
• Determine if surgical consultation is needed
Cleanse, debride and probe the wound
Classify the wound (if infected)
Mild/Moderate
• Assess the need for inpatient treatment
• Review any available microbiological data
• Select initial antibiotic regimen (consider
oral, relatively narrow-spectrum)
• Select appropriate wound care (dressings,
off-loading)
• If treated as outpatient, set up return visit,
consultations
• Arrange for investigation or surgery if
needed
• If not hospitalized, reassess in 2-4 days,
or earlier if substantially worse
Severe
Hospitalize the patient
• Consider obtaining blood cultures
• Attend to fluid, electrolyte, metabolic needs
• Select empiric, broad-spectrum parenteral
antibiotic regimen (consider multi-drug
resistant organisms)
• Arrange for urgent surgery, if needed
• Reassess clinically at least once daily
• Check inflammatory markers as needed
Improving
Improving
Consider
de-escalating
antibiotic
regimen
(narrower
spectrum, less
toxic/expensive)
Not improving/
worsening
• Review culture &
sensitivity results
• Assess patient's adherence
to treatment regimen
• Reassess wound care, need
to hospitalize
• Consider further imaging
• Reculture wound
• Reassess ~ weekly until infection resolves
• If fails to resolve or relapses, consider deep
abscess, osteomyelitis or resistant pathogen
Not improving/
worsening
Switch to appropriate oral
antibiotic regimen
Follow-up as outpatient
• Define extent of tissue involved (MRI,
surgical exploration)
• Review culture & sensitivity results;
cover all isolates
• Reassess need for surgery, including
revascularization or amputation
Consider broadening antibiotic spectrum
