Diabetic Foot Infection

Treatment Criteria & Considerations

  • Consider prior wound microbiology results when selecting an empiric therapy

MRSA Risk Factors:

  • History of MRSA infection or colonization

  • Household contact with a MRSA colonized individual

  • IV drug use

  • Homelessness

  • Incarcerated persons

  • Recent travel to or residing in an MRSA endemic region or community

  • In a clinically infected wound a positive probe-to-bone (PTB) test is highly suggestive of osteomyelitis.

  • Plain x-ray also recommended. Repeat in 2 weeks, if initial x-ray normal and high probability of osteomyelitis.

Management & Work-Up

Debridement, good glycemic control, proper wound care, vascular assessment and smoking cessation are essential for the management of diabetic foot infections

  • Recommend to start with plain radiography (radionuclide imaging generally not necessary)

  • Prefer tissue specimens post-debridement and cleansing of wound; surface or wound drainage swabs not recommended

Definitions

  • Cellulitis <2 cm and without involvement of deeper tissues

  • Non-limb threatening

  • No signs of sepsis

  • Cellulitis >2 cm or involvement of deeper tissues

  • Non-limb threatening

  • No signs of sepsis

  • Signs of sepsis

  • Limb or foot threatening

  • Extensive soft tissue involvement or deeper tissues (i.e. bone, joint or tendon spaces)

  • Pulseless foot

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Empiric Antimicrobial Therapy for Diabetic Foot Infection. 09-2019.

  1. Bowering K, Embil JM. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Foot Care. Can J Diabetes 37(2013) S145-S149
  2. Lipsky BA, Berendt AR, Cornia PB et al. 2012 Infectious Disease Society of America Clinical Practice Guidelines for the Diagnosis and Treatment of Diabetic Foot Infections. CID 2012:54(12):132-173
  3. Lipsky BA, Armstrong DG, Citron DM et al. Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomized, controlled, double-blinded, multicentre trial. Lancet 2005; 366:1695 – 1703
  4. Blond-Hill E, Fryters S. Bugs & Drugs An Antimicrobial/Infectious Diseases Reference. 2012. Alberta Health Services