Assessment Hospitalization
ÎAll patients with a severe infection, selected patients with a moderate 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).
ÎPrior 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
ÎFor clinically uninfected wounds, do NOT collect a specimen for culture (SR-L).
ÎFor 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).
ÎSpecimens 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
ÎAll 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).
ÎMagnetic 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).
ÎWhen 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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