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IDSA Practice Guideline for the Treatment of Diabetic Foot Infections
Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections
Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Read full text guideline
could you provide some clarification on empiric antiobiotic choice?
In table 8,
under moderate or severe DFIs, we have the following probable pathogens
Streptococcus spp; Enterobacteriaceae; obligate anaerobes
everything clear; these are the pts with no risk for MRSA or Pseudomonas; treat
them with “usual” antibiotics
2) MRSA –
treat with linezolid, daptomycin, or vancomycin
Pseudomonas - piperacillin-tazobactam
4) MRSA, Enterobacteriacae,
Pseudomonas, and obligate anaerobes; suggested antibiotics: vancomycin,
ceftazidime, cefepime, piperacillin-tazobactam, aztreonam, or a carbapenem.
Now I have
trouble – what clinical scenario is it? Did you mean patients with risk factors
for both MRSA and Pseudomonas, and hence the need for very broad-spectrum
antibiotics? If so, then we should probably use vancomycin (linezolid,
daptomycin) AND one of the remaining (or, maybe more specifically, vancomycin
plus piperacillin-tazobactam, because the latter is preferred for Pseudomonas).
Why this list is longer, if required spectrum is broader?