Assessment
Hospitalization
ÎAll patients with a severe infection, selected patients with a moderate
Î
infection with complicating features (eg, severe peripheral arterial
disease or lack of home support), and any patient unable to comply with
the required outpatient treatment regimen for psychological or social
reasons, should be hospitalized initially. Patients who do not meet any of
these criteria, but are failing to improve with outpatient therapy, may also
need to be hospitalized (SR-L).
ÎÎPrior to being discharged a patient with a DFI should (SR-L):
• be clinically stable
• have had any urgently needed surgery performed
• have achieved acceptable glycemic control
• be able to manage (alone or with help) at the designated discharge location
• have a well-defined plan that includes:
▶▶ an appropriate antibiotic regimen to which he/she will adhere
▶▶ an off-loading scheme (if needed)
▶▶ specific wound care instructions
▶▶ appropriate outpatient follow-up
Microbiology
ÎÎFor clinically uninfected wounds, do NOT collect a specimen for
culture (SR-L).
ÎÎFor infected wounds, send appropriately obtained specimens for culture
prior to starting empirical antibiotic therapy, if possible (SR-L).
Note: Cultures may be unnecessary for a mild infection in a patient who has not
recently received antibiotic therapy (SR-L).
ÎÎSpecimens for culture should be from deep tissue, obtained by biopsy
or curettage and after the wound has been cleansed and debrided.
Avoid swab specimens, especially of inadequately debrided wounds,
since they provide less accurate results (SR-M).
Imaging Studies
ÎÎAll patients presenting with a new DFI should have plain radiographs
of the affected foot to look for bony abnormalities (deformity,
destruction) as well as for soft tissue gas and radio-opaque foreign
bodies (SR-M).
ÎÎMagnetic resonance imaging (MRI) is the study of choice for
patients who require further (ie, more sensitive or specific) imaging,
particularly when soft tissue abscess is suspected or the diagnosis of
osteomyelitis remains uncertain (SR-M).
ÎÎWhen MRI is unavailable or contraindicated, consider the combination
of a radionuclide bone scan and a labeled white blood cell scan as the
best alternative (WR-L).
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