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Diabetic foot infection.
Am Fam Physician. 2008 Jul 01; 78(1):71-9.AF

Abstract

Foot infections are common in patients with diabetes and are associated with high morbidity and risk of lower extremity amputation. Diabetic foot infections are classified as mild, moderate, or severe. Gram-positive bacteria, such as Staphylococcus aureus and beta-hemolytic streptococci, are the most common pathogens in previously untreated mild and moderate infection. Severe, chronic, or previously treated infections are often polymicrobial. The diagnosis of diabetic foot infection is based on the clinical signs and symptoms of local inflammation. Infected wounds should be cultured after debridement. Tissue specimens obtained by scraping the base of the ulcer with a scalpel or by wound or bone biopsy are strongly preferred to wound swabs. Imaging studies are indicated for suspected deep soft tissue purulent collections or osteomyelitis. Optimal management requires aggressive surgical debridement and wound management, effective antibiotic therapy, and correction of metabolic abnormalities (mainly hyperglycemia and arterial insufficiency). Treatment with antibiotics is not required for noninfected ulcers. Mild soft tissue infection can be treated effectively with oral antibiotics, including dicloxacillin, cephalexin, and clindamycin. Severe soft tissue infection can be initially treated intravenously with ciprofloxacin plus clindamycin; piperacillin/tazobactam; or imipenem/cilastatin. The risk of methicillin-resistant S. aureus infection should be considered when choosing a regimen. Antibiotic treatment should last from one to four weeks for soft tissue infection and six to 12 weeks for osteomyelitis and should be followed by culture-guided definitive therapy.

Authors+Show Affiliations

Memorial University of Newfoundland School of Medicine, St. John's, Newfoundland, Canada. msbader1@hotmail.com

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18649613

Citation

Bader, Mazen S.. "Diabetic Foot Infection." American Family Physician, vol. 78, no. 1, 2008, pp. 71-9.
Bader MS. Diabetic foot infection. Am Fam Physician. 2008;78(1):71-9.
Bader, M. S. (2008). Diabetic foot infection. American Family Physician, 78(1), 71-9.
Bader MS. Diabetic Foot Infection. Am Fam Physician. 2008 Jul 1;78(1):71-9. PubMed PMID: 18649613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic foot infection. A1 - Bader,Mazen S, PY - 2008/7/25/pubmed PY - 2008/8/23/medline PY - 2008/7/25/entrez SP - 71 EP - 9 JF - American family physician JO - Am Fam Physician VL - 78 IS - 1 N2 - Foot infections are common in patients with diabetes and are associated with high morbidity and risk of lower extremity amputation. Diabetic foot infections are classified as mild, moderate, or severe. Gram-positive bacteria, such as Staphylococcus aureus and beta-hemolytic streptococci, are the most common pathogens in previously untreated mild and moderate infection. Severe, chronic, or previously treated infections are often polymicrobial. The diagnosis of diabetic foot infection is based on the clinical signs and symptoms of local inflammation. Infected wounds should be cultured after debridement. Tissue specimens obtained by scraping the base of the ulcer with a scalpel or by wound or bone biopsy are strongly preferred to wound swabs. Imaging studies are indicated for suspected deep soft tissue purulent collections or osteomyelitis. Optimal management requires aggressive surgical debridement and wound management, effective antibiotic therapy, and correction of metabolic abnormalities (mainly hyperglycemia and arterial insufficiency). Treatment with antibiotics is not required for noninfected ulcers. Mild soft tissue infection can be treated effectively with oral antibiotics, including dicloxacillin, cephalexin, and clindamycin. Severe soft tissue infection can be initially treated intravenously with ciprofloxacin plus clindamycin; piperacillin/tazobactam; or imipenem/cilastatin. The risk of methicillin-resistant S. aureus infection should be considered when choosing a regimen. Antibiotic treatment should last from one to four weeks for soft tissue infection and six to 12 weeks for osteomyelitis and should be followed by culture-guided definitive therapy. SN - 0002-838X UR - https://www.unboundmedicine.com/medline/citation/18649613/Diabetic_foot_infection_ L2 - https://www.aafp.org/link_out?pmid=18649613 DB - PRIME DP - Unbound Medicine ER -
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