Treatment
Figure 2. Approach to the Infected Diabetic Foot Diabetic patient with a suspected foot infection
• Assess for purulence or signs of inflammation
• Assess neurological and vascular status of foot
• Assess any medical co-morbidities • 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 appropriate wound care (dressings, off-loading)
• Select initial antibiotic regimen (consider oral, relatively narrow-spectrum)
• If treated as outpatient, set up return visit, consultations
• Arrange for investigation or surgery if needed—eg, in suspected abscess or osteomyelitis.
• If not hospitalized, reassess in 2-4 days, or earlier if substantially worse.
Improving
de-escalating antibiotic regimen
Consider
spectrum, less toxic/expensive
(narrower
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
14 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
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
