Diabetic Foot Infections (DFIs)
Severe

Severe

Clinical Considerations

Local infection with the signs of SIRS, as manifested by ≥2 of the following:

  • Temp >38°C or <36°C
  • HR >90 beats/min
  • RR >20 breaths/min or PaCO₂ <32 mmHg
  • WBC >12,000 or <4,000 or ≥10% bands
  • Inappropriate and over-prescribing of antibiotics is common for DFIs, which may lead to antibiotic resistance
  • The majority of inpatient severe cases that are hemodynamically stable can use ceftriaxone + metronidazole ± vancomycin IV (if risk factors for MRSA)
  • Levofloxacin: inferior agent for microaerophillic Streptococcus and gram-negatives; no anaerobic coverage
  • Aztreonam: inferior agent for Pseudomonas spp.; no coverage for gram-positives and anaerobes
  • Unless previous reaction to penicillin derivative is anaphylaxis, consider a cephalosporin over other agents
    • Refer to “Beta-lactam Allergy Quick Sheet” for further guidance on cross-reactivity and assessment of allergy history

Microbiology