Guidelines
Diabetic Foot Infection (DFI)

Diabetic Foot Infection (DFI)

Microbiology

Clinical Considerations

Contiguous disease WITH vascular insufficiency

  • Do NOT culture a clinically uninfected lesion, unless for specific epidemiological purposes 
  • Do NOT obtain a specimen for culture without first cleansing or debriding the wound 
  • Do NOT obtain a specimen for culture by swabbing the wound or wound drainage
  • History of MRSA infection and/or (+) nasal swabs
  • IVDU
  • Chronic wounds
  • Incarceration

Usually unnecessary except for patients with risk factors for true infection with this organism

Treatment

No symptoms or signs of infection

Infection present, as defined by the presence of at least 2 of the following items:

  • Local swelling or induration
  • Erythema
  • Local tenderness or pain
  • Local warmth
  • Purulent dischrage (think, opaque to white or sanguineous secretion)
  • Local infection involving only the skin and the subcutaneous tissue (without involvement of deeper tissues and without systemic signs)
  • If erythema, must be > 0.5 cm to ≤ 2 cm around the ulcer
  • Exclude other causes of an inflammatory response of the skin (e.g. trauma, gout, acute Charcot neuro-osteoarthropathy, fracture, thrombosis, venous stasis)
  • Local infection involving only the skin and the subcutaneous tissue
  • AND erythema > 2 cm or involving structures deeper than skin and subcutaneous tissues (e.g. abscess, osteomyelitis, septic arthritis, fasciitis)
  • AND no systemic inflammatory response signs:
    • Temperature > 38°C or < 36°C
    • Heart rate > 90 beats/min
    • Respiratory rate > 20 breaths/min or PaCO2 < 32 mm Hg
    • White blood cell count > 12000 or < 4000 cells/μL or ≥ 10% immature (band) forms
  • Local infection involving only the skin and the subcutaneous tissue
  • AND the signs of SIRS, as manifested by ≥ 2 of the following:
    • Temperature > 38°C or < 36°C
    • Heart rate > 90 beats/min
    • Respiratory rate > 20 breaths/min or PaCO2 < 32 mm Hg
    • White blood cell count > 12000 or < 4000 cells/μL or ≥ 10% immature (band) forms

More Information

Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun;54(12):e132-73. doi: 10.1093/cid/cis346. PMID: 22619242.