Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Diabetic Foot Infection (DFI)

Note

All dosages assume normal renal and hepatic function

Definitive antimicrobial therapy should be based on deep tissue culture results

Empiric Antimicrobial Therapy

Non-limb-threatening + Superficial

Superficial: Limited in size and depth, erythema >0.5cm to ≤2cm around the ulcer

Non-limb-threatening + Deep

Deep: Involving structures deeper than skin and subcutaneous tissues (e.g. abscess, osteomyelitis, septic arthritis, fasciitis)

Limb-threatening

Limb-threatening: Systemic toxicity (i.e. hypotension), critical ischemia (i.e. wet gangrene), ICU admission, or qSOFA score ≥2

Management of Special Situations

Human/animal bites

Cat bites are more likely to cause deep infections, including osteomyelitis/septic joints

Suspicion for water pathogens

  • Aeromonas hydrophilia

  • Vibrio vulnificus

Cellulitis surrounding sacral decubitus ulcers

More Information

References

  1. Stevens DL, Bisno AL, Chambers HF et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014 59: e10-52.

  2. Pichichero ME. Cephalosporins can be prescribed safely for penicillin-allergic patients. J Fam Pract 2006 55: 106-112.

  3. Lipsky BA, Berendt AR, Cornia PB, et al 2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections. Clin Infect Dis 2012; 54: 132 173.