Guidelines
Diabetic Foot Ulcers

Diabetic Foot Ulcers

Microbiology

Treatment Considerations

The fundamental pathology of an ulcer is one of local ischemia therefore, any antibiotic in the bloodstream will not reach the ulcer

Topical antibiotic use is strongly discouraged

The organisms isolated from swabs of ulcers may represent what is present in the ulcer rather than what is invading nearby tissue

The complications of ulcers (cellulitis, osteomyelitis, etc.) should be managed as normal but it must be understood that antibiotic treatment is being given for these reasons NOT for the ulcer

Where there is evidence of infection seek specialist advice from Vascular surgery

Antimicrobial Treatment

  • Cellulitis extends ≤2cm, and presence of ≥2 of:
    • Purulence
    • Erythema
    • Pain
    • Tenderness
    • Warmth
    • Induration
  • Only skin/superficial soft tissues involved
  • No local complications
  • Not systemically unwell
  • Cellulitis extends >2cm, and presence of ≥2 of:
    • Purulence
    • Erythema
    • Pain
    • Tenderness
    • Warmth
    • Induration
  • Lymphangitis
  • Spread beyond superficial fascia
  • Gangrene
  • Involvement of muscle/tendon/joint/bone
  • May be limb-threatening
  • Systemic toxicity or metabolic instability, or patients admitted acutely to hospital because of diabetic foot infection (with or without suspected osteomyelitis)
  • Signs of systemic inflammatory response syndrome (SIRS), as manifested by ≥ of the following:
    • Temperature >38°C or <36°C
    • Heart rate >90 beats/minute
    • Respiratory rate >20 breaths/minute or PaCO2 <32 mm Hg
  • May be life-threatening

More Information

  • Approval date: September 2022
  • Next revision date: September 2024