Diabetic/Vascular Ulcer Infection

These complex infections often require multidisciplinary management, including wound care, surgical specialties and Infectious Diseases.

Consider revascularization prior to definitive debridement.

Staphylococcus and Streptococcus are the most common pathogens.

Consider deeper infection (osteomyelitis, septic arthritis).

Exposed bone, or a wound that probes to bone, means osteomyelitis.

Chronic wounds are not necessarily infected – assess for increased pain, erythema, warmth, edema, purulence, and signs of systemic toxicity.

Tissue specimens (i.e. bone) for culture are often needed to guide therapy and are more reliable than superficial wound swabs.

If deep infection is suspected and the patient is systemically well, antibiotics should be delayed until after a tissue/bone specimen is obtained for culture.

Osteomyelitis is often diagnosed without imaging.

Plain radiograph is the best first test.

MRI is the definitive imaging modality.

Nuclear images (bone scan and WBC scan) are non-specific for lesions contiguous with the skin, and are not recommended.