IDSA GUIDELINES Bundle

Diabetic Foot Infections Without Osteomyelitis

IDSA GUIDELINES Apps brought to you free of charge courtesy of Guideline Central. All of these titles are available for purchase on our website, GuidelineCentral.com. Enjoy!

Issue link: http://eguideline.guidelinecentral.com/i/229086

Contents of this Issue

Navigation

Page 2 of 3

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

Articles in this issue

Archives of this issue

view archives of IDSA GUIDELINES Bundle - Diabetic Foot Infections Without Osteomyelitis