Day 5 - Diabetic Foot Infection

JAMA RCE: Does this patient with Diabetes have osteomyelitis of the Lower Extremity?

• Probe to bone - + LR 4-9

• Exposed bone - + LR 9

• Ulcer size > 2 cm - +LR 7

• ESR > 70 - + LR 6 - 19

IDSA Guidelines for Diabetic Foot Infection:

• Multifactorial approach including: glycemic control, foot offloading, wound care with debridement and antibiotics for infection recommended

• MRI is the gold standard for imaging, but x-rays may be appropriate for initial assessment

• Wound swabs recommended for culture after debridement. Superficial tissues likely to culture superficial flora.

Potential Empiric Regimen:

• Superficial Infection

  • Cephalexin 500mg PO QID

  • Amoxicillin-Clavulinic acid 875/125 mg po 1 tablet BID

• Deep Ulcers to Fascia

  • Cefazolin 1-2g IV q8h + Metronidazole 500mg PO/IV TID

  • Ceftraxone 1-2g IV q24h + Metronidazole 500mg PO/IV TID

• Severe, Limb-threatening infections

  • Pip-Tazo 4.5g IV x 1, then 3.375g IV q8h + Vancomycin 15-20mg/kg IV x 1 loading dose, then 1g IV BID (or renal dose)

  • Ertapenem 1g IV q24h + Vancomycin '

  • Flagyl 500mg PO q8h + Cephalexin 500mg PO QID + Ciprofloxacin 500mg PO BID (Oral regimen)