Consider Infectious Diseases, Wound Care and Vascular Surgery consultations to assist with antimicrobial regimen and long-term management.

Staphylococcus aureus and beta-hemolytic Streptococcus are still the most important causative pathogens of diabetic foot infections.

Suspect deeper infections such as osteomyelitis in cases where ulcer area is greater than 2x2cm or positive probe to bone test.

Chronic wounds are not necessarily infected – assess for increased pain, erythema, warmth, edema, purulence, and signs of systemic toxicity.

Deep tissue specimens (i.e. bone tissue) for C&S are often needed to guide therapy and are more reliable than superficial wound swabs. Superficial wound swabs are more likely to reflect colonizers and contaminants.

If deep infection is suspected and patients are systemically well, antibiotics should be delayed until after a deep tissue/bone specimen is obtained for culture.