DIABETIC FOOT INFECTIONS STUDY GUIDE 2024 LATEST UPDATE

what are diabetic foot infections? - simple ulcer - severe gangrenous infection - very rapid progression - neuropathic damage, compromised blood flow = high risk - most common cause of amputations in diabetics what are the pathogens of acute diabetic foot infections? usually monomicrobial - staph (including MRSA) - strep what are the pathogens of chronic diabetic foot infections? usually polymicrobial - enterococcus - anaerobes - enterobacteriaceae - pseudomonas - resistant organisms (MRSA, VRE, ESBL) what is the pathophysiology of diabetic foot infections? neuropathy - angiopathy and ischemia ---- immunologic defects what are the risk factors? - peripheral neuropathy - neuro-osteoarthropathic deformaties - vascular insufficiency - hyperglycemia (impaired immune system) - immobility what is the diagnosis of diabetic foot infections? - purulent secretions - inflammation - redness - warmth - swelling - pain - tenderness (must have at least two of these characteristics) what is P.E.D.I.S.? - perfusion - extent/side - depth/tissue loss - infection - sensation helps diagnose - grading system what is a PEDIS grade 1 infection? uninfected no real symptoms no treatment what is a PEDIS grade 2 infection? mild purulence presence of inflammation limited to superficial tissues outpatient what is a PEDIS grade 3 infection? moderate cellulitis 2cm lymphamgitic streaking spread beneath superficial fascia deep tissue abscesses gangrene involves muscle, tendon, joint, bone outpatient or inpatient what is a PEDIS grade 4 infection? severe systemic tox metabolic instability (fever, chill, tachycardia, hypotension, confusion) inpatient what is nonpharm treatment? - comprehensive foot care - optimize glucose control - smoking cessation - rest - elevation of bed to decrease edema - surgery/amputation what is comprehensive foot care? - periodic foot exam (callus, blisters, trauma, etc) - properly fitted shoes - no barefoot - clean and dry - toenails cut what are the oral antibiotics for mild, grade 2 infections MSSA? - cephalexin - dicloxacillin - clindamycin what are the oral antibiotics for mild, grade 2 infections gram (+), gram (-), recent antibiotic use? - augmentin - levofloxacin what are the oral antibiotics for mild, grade 2 infections MRSA? - bactrim - doxycycline - clindamycin - linezolid what are the oral antibiotics for moderate, grade 3 infections gram (+), gram (-), anaerobic, NO PSEUDOMONAS? - moxifloxacin - amoxicillin/clavulanate what are the oral antibiotics for moderate, grade 3 infections gram (+), gram (-), anaerobic, WITH RISK PSEUDOMONAS? - levofloxacin + clindamycin - ciprofloxacin + clindamycin what are the oral antibiotics for moderate, grade 3 infections MRSA? - doxycycline - linezolid what are the IV antibiotics for moderate, grade 3 infections gram (+), gram (-), anaerobic, NO PSEUDOMONAS? - ertapenem - ceftriaxone + clindamycin - cefoxitin/cefotetan - unasyn what are the IV antibiotics for moderate, grade 3 infections gram (+), gram (-), anaerobic, RISK OF PSEUDOMONAS? - zosyn - cefepime + clindamycin - aztreonam + clindamycin - levofloxacin + clindamycin - ciprofloxacin + clindamycin what are the IV antibiotics for moderate, grade 3 infections MRSA? - vancomycin - linezolid - daptomycin what are the IV antibiotics for severe, grade 4 infections gram (+), gram (-) w/pseudomonas, and anaerobic NO MRSA? - zosyn - imepenem cilastatin - cefepime + clindamycin/metronidazole - aztreonam + clindamycin/metronidazole