Management

Avoid fluoroquinolones in patients who received them as outpatient therpay.

Clean and debride wound(s) before obtaining specimens for culture.

Non-surgical swabs often reveal Pseudomonas spp. and/or Enterococcus spp. but studies and guidelines support that these are common colonizers and rarely the cause of infection.

Putrid discharge is diagnositic for the presence of anaerobes

Ulcer floor should be probed carefully. If bone can be touched with a metal probe then the patient should be treated for presumed osteomyelitis in addition to possible surgical debridement.

MRI is more sensitive and specific for detection of soft-skin lesions and osteomyelitis.