Guidelines
Diabetic Foot Infection

Diabetic Foot Infection

Clinical Considerations

Considered cellulitis, treat as cellulitis

  • Chronic wounds are not necessarily infected and do not require antibiotics
  • Assess for increased pain, erythema, warmth, edema, purulence, and signs of systemic toxicity

Microbiology

Diagnostics

Obtain an appropriate specimen for culture & gram stain from infected wounds:

  • Cleanse and debride wound before obtaining specimen(s) for culture
  • Do NOT culture a wound that appears uninfected
  • Do NOT obtain a specimen by swabbing the wound or drainage
  • Plain x-ray recommended
  • Repeat in 2 weeks if initial x-ray normal and high probability of osteomyelitis

Preferred Therapy

  • Erythema ≥ 0.5 cm but ≤2 cm
  • No deep tissue involvement
  • No systemic toxicity
  • Erythema >2 cm

OR

  • Deep tissue involvement: abscess, osteomyelitis, septic arthritis, fascitis, gangrene
  • No systemic toxicity
  • Erythema >2 cm

OR

  • Deep tissue involvement: abscess, osteomyletis, septic arthritis, fascitis, gangrene

PLUS

  • Systemic toxicity or hemodynamic instability