Treatment
Table 5. Recommendations for Collection of Specimens for Culture from Diabetic Foot Wounds
ÎDo
• Obtain an appropriate specimen for culture from almost all infected wounds • Cleanse and debride the wound before obtaining specimen(s) for culture • Obtain a tissue specimen for culture by scraping with a sterile scalpel or dermal curette (curettage) or biopsy from the base of a debrided ulcer
• Aspirate any purulent secretions using a sterile needle and syringe • Promptly send specimens in a sterile container or appropriate transport media for aerobic and anaerobic culture (and Gram-stain, if possible)
Î DO NOT
• Culture a clinically uninfected lesion, unless for specific epidemiological purposes
• Obtain a specimen for culture without first cleansing or debriding the wound • Obtain a specimen for culture by swabbing the wound or wound drainage
Table 6. Antibiotic Selection Overview: Questions a Clinician Should Consider
ÎIs there clinical evidence of infection? • Do NOT treat clinically uninfected wounds with antibiotics
For clinically infected wounds consider the questions below ÎIs there high risk of MRSA?
• Include anti-MRSA therapy in empiric regimen if the risk is high (see Table 7) or the infection is severe
ÎHas patient received antibiotics in the past month?
• If so, include agents active against Gram-negative bacilli in regimen • If not, agents targeted against just aerobic Gram-positive cocci may be sufficient
ÎAre there risk factors for Pseudomonas infection? (Such as high local prevalence of Pseudomonas infection, warm climate, frequent exposure of the foot to water)
• If so, consider empiric anti-pseudomonal agent • If not, empiric anti-pseudomonal treatment is rarely needed
ÎWhat is the infection severity status? • See Table 7 for suggested regimens for mild versus moderate/severe infections
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