Diabetic foot infection - Revision history

Aidan: /* WIfI System */ moved to own page

2025-09-18T17:00:19Z

WIfI System: moved to own page

← Older revision		Revision as of 17:00, 18 September 2025
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	=== WIfI System ===		=== WIfI System ===

			* The [[WIfI system]] is used to stage at-risk limbs in patients with peripheral artery disease, including those with diabetes
	==== Wound ====
			* Components include Wound, Ischemia, and foot Infection
	{\| class="wikitable"
			* Clinical stage from 0 (very low) to 3 (high) which predicts amputation risk
	!Grade
	!DFU
	!Gangrene
	!Description
	\|-
	\|0
	\|No ulcer
	\|No gangrene
	\|Minor tissue loss. Salvageable with simple digital amputation or skin coverage.
	\|-
	\|1
	\|Small, shallow ulcer on distal leg or foot; no exposed bone, unless limited to distal phalanx
	\|No gangrene
	\|Minor tissue loss. Salvageable with simple digital amputation or skin coverage
	\|-
	\|2
	\|Deeper ulcer with exposed bone, joint, or tendon; generally not involving the heel; shallow heel ulcer, without calcaneal involvement
	\|Gangrene limited to digits
	\|Major tissue loss salvageable with multiple digital amputation or standard TMA ± skin coverage
	\|-
	\|3
	\|Extensive deep ulcer involving forefoot and/or midfoot; deep full thickness heel ulcer ± calcaneal involvement
	\|Extensive gangrene involving forefoot and/or midfoot; full thickness heel necrosis ± calcaneal involvement
	\|Extensive tissue loss salveagable only with a complex foot reconstruction or non-traditional TMA (Chopart or Lisfranc); flap coverage or complex wound management needed for large soft tissue defect
	\|}

	==== Ischemia ====
	{\| class="wikitable"
	!Grade
	!ABI
	!Ankle SBP (mmHg)
	!Toe pressure, TcPO2 (mmHg)
	\|-
	\|0
	\|≥0.8
	\|>100
	\|≥60
	\|-
	\|1
	\|0.6-0.79
	\|70-100
	\|40-59
	\|-
	\|2
	\|0.4-0.59
	\|50-70
	\|30-39
	\|-
	\|3
	\|≤0.39
	\|<50
	\|<30
	\|}

	==== Foot Infection ====
	{\| class="wikitable"
	!Grade
	!Clinical Description
	\|-
	\|0
	\|No signs or symptoms of infection.
	\|-
	\|1
	\|Infection present with at least 2 of: local swelling or induration; erythema 0.5 to 2 cm around the ulcer; local tenderness or pain; local warmth; purulent discharge. Local infection involving only the skin and subcutanous tissue, without involvement of deeper tissues and without systemic signs. Excludes other causes of inflammation such as trauma, gout, acute Charcot foot, fracture, thrombosis, venous stasis.
	\|-
	\|2
	\|Local infection (as above) with erythema >2 cm around ulcer or involving deeper structures (abscess, osteomyelitis, septic arthritis, fasciitis), without systemic signs of infection.
	\|-
	\|3
	\|Local infection (as above) with systemic signs of infection ([[SIRS]]) with at least 2 of: temperature <36ºC or >38ºC; heart rate >90 bpm; respiratory rate >20 bpm or PaCO<sub>2</sub> <32 mmHg; WBC <4 or >12 or 10% bands
	\|}

	==Diagnosis==		==Diagnosis==

Aidan at 16:19, 18 September 2025

2025-09-18T16:19:43Z

@@ Line 14: / Line 14: @@
 **[[Anaerobes]], including [[Bacteroides fragilis]]
 *Anaerobes are more likely to be involved in deeper, more chronic ulcers
 ==Diagnosis==

Aidan at 15:57, 18 September 2025

2025-09-18T15:57:16Z

← Older revision		Revision as of 15:57, 18 September 2025
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	==Background==		==Background==

			* Foot infection in a patient with [[diabetes mellitus]], typically superimposed infection of a preexisting [[diabetic foot ulcer]]

	===Microbiology===		===Microbiology===

Aidan: Text replacement - " species]]" to "]]"

2022-01-28T04:02:46Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 04:02, 28 January 2022
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	**[[Staphylococcus aureus]], which is by far the most common cause of monomicrobial infections		**[[Staphylococcus aureus]], which is by far the most common cause of monomicrobial infections
	**[[Coagulase-negative staphylococci]]		**[[Coagulase-negative staphylococci]]
	**[[Streptococcus ~~species~~]]		**[[Streptococcus]]
	**[[Enterococcus ~~species~~]]		**[[Enterococcus]]
	**[[Enterobacteriaceae]]		**[[Enterobacteriaceae]]
	**[[Pseudomonas aeruginosa]]		**[[Pseudomonas aeruginosa]]
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	\|-		\|-
	\| rowspan="7" \|Mild		\| rowspan="7" \|Mild
	\| rowspan="5" \|methicillin-susceptible [[Staphylococcus aureus]], [[Streptococcus ~~species~~]]		\| rowspan="5" \|methicillin-susceptible [[Staphylococcus aureus]], [[Streptococcus]]
	\|[[dicloxacillin]]		\|[[dicloxacillin]]
	\|qid dosing and very narrow-spectrum		\|qid dosing and very narrow-spectrum
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	\|-		\|-
	\| rowspan="13" \|moderate or severe		\| rowspan="13" \|moderate or severe
	\| rowspan="9" \|[[MSSA]], [[Streptococcus ~~species~~]], [[Enterobacteriaceae]], [[anaerobes]]		\| rowspan="9" \|[[MSSA]], [[Streptococcus]], [[Enterobacteriaceae]], [[anaerobes]]
	\|[[levofloxacin]]		\|[[levofloxacin]]
	\|suboptimal against MSSA		\|suboptimal against MSSA

Aidan: /* Microbiology */

2021-01-13T23:10:30Z

Microbiology

← Older revision		Revision as of 23:10, 13 January 2021
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	**[[Coagulase-negative staphylococci]]		**[[Coagulase-negative staphylococci]]
	**[[Streptococcus species]]		**[[Streptococcus species]]
	**[[~~ENterococcus~~ species]]		**[[Enterococcus species]]
	**[[Enterobacteriaceae]]		**[[Enterobacteriaceae]]
	**[[Pseudomonas aeruginosa]]		**[[Pseudomonas aeruginosa]]

Aidan at 23:09, 13 January 2021

2021-01-13T23:09:11Z

← Older revision		Revision as of 23:09, 13 January 2021
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	*Anaerobes are more likely to be involved in deeper, more chronic ulcers		*Anaerobes are more likely to be involved in deeper, more chronic ulcers

	== Diagnosis ==		==Diagnosis==

	* Osteomyelitis should be considered in all cases of diabetic foot infection		*Osteomyelitis should be considered in all cases of diabetic foot infection
	** [[Probe-to-bone test]] should be done routinely		**[[Probe-to-bone test]] should be done routinely
	** Plain film X-ray can be helpful, though not sensitive		**Plain film X-ray can be helpful, though not sensitive
	** MRI is the preferred diagnostic test, followed by bone and white cell scan		**MRI is the preferred diagnostic test, followed by bone and white cell scan
	** The gold standard is still bone biopsy for histopathology and culture		**The gold standard is still bone biopsy for histopathology and culture

	==Management==		==Management==
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	\|}		\|}

	=== Duration ===		===Duration===
			{\| class="wikitable"
			!Site of Infection
			!Severity
			!Duration
			\|-
			\| rowspan="3" \|soft tissue only
			\|mild
			\|1 to 2 weeks; up to 4 weeks if slow-to-resolve
			\|-
			\|moderate
			\|1 to 3 weeks
			\|-
			\|severe
			\|2 to 4 weeks
			\|-
			\| rowspan="4" \|bone and joint infection
			\|postamputation, with no residual infection
			\|2 to 5 days
			\|-
			\|postamputation, with residual soft tissue infection
			\|1 to 3 weeks
			\|-
			\|postamputation, with residual bone infection
			\|4 to 6 weeks
			\|-
			\|no surgery
			\|≥3 months
			\|}

	*After amputation or resection
	**If good source control, only 2 to 5 days is recommended
	**If there is persistent infection or necrotic bone, 4 or more weeks
	*Osteomyelitis		*Osteomyelitis
	**Traditionally, 6 weeks of parenteral therapy		**Traditionally, 6 weeks of parenteral therapy

Aidan at 23:04, 13 January 2021

2021-01-13T23:04:06Z

← Older revision		Revision as of 23:04, 13 January 2021
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	**[[Anaerobes]], including [[Bacteroides fragilis]]		**[[Anaerobes]], including [[Bacteroides fragilis]]
	*Anaerobes are more likely to be involved in deeper, more chronic ulcers		*Anaerobes are more likely to be involved in deeper, more chronic ulcers

			== Diagnosis ==

			* Osteomyelitis should be considered in all cases of diabetic foot infection
			** [[Probe-to-bone test]] should be done routinely
			** Plain film X-ray can be helpful, though not sensitive
			** MRI is the preferred diagnostic test, followed by bone and white cell scan
			** The gold standard is still bone biopsy for histopathology and culture

	==Management==		==Management==
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	\|}		\|}

			=== Duration ===

			*After amputation or resection
			**If good source control, only 2 to 5 days is recommended
			**If there is persistent infection or necrotic bone, 4 or more weeks
	*Osteomyelitis		*Osteomyelitis
	**Traditionally, 6 weeks of parenteral therapy		**Traditionally, 6 weeks of parenteral therapy

Aidan at 20:19, 13 January 2021

2021-01-13T20:19:00Z

@@ Line 4: / Line 4: @@
 *Typically polymicrobial, including:
-**[[Staphylococcus species]]
+**[[Staphylococcus aureus]], which is by far the most common cause of monomicrobial infections
 **[[Streptococcus species]]
-**[[Anaerobes]]
+**[[Enterobacteriaceae]]
 *Anaerobes are more likely to be involved in deeper, more chronic ulcers
 ==Management==
 *Osteomyelitis

Aidan: /* Management */

2021-01-13T19:23:34Z

Management

← Older revision		Revision as of 19:23, 13 January 2021
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	== Background ==		==Background==

	===Microbiology===		===Microbiology===
Line 10:		Line 10:
	*Anaerobes are more likely to be involved in deeper, more chronic ulcers		*Anaerobes are more likely to be involved in deeper, more chronic ulcers

	== Management ==		==Management==

	* Osteomyelitis		*Osteomyelitis
	** Traditionally, 6 weeks of parenteral therapy		**Traditionally, 6 weeks of parenteral therapy
	** May be able to shorten to 3 weeks based on more recent evidence[[CiteRef::gariani2020th]]		**May be able to shorten to 3 weeks if adequately debrided, based on more recent evidence[[CiteRef::gariani2020th]]

	==Further Reading==		==Further Reading==

Aidan at 19:22, 13 January 2021

2021-01-13T19:22:43Z

← Older revision		Revision as of 19:22, 13 January 2021
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	== ~~Microbiology~~ ==		== Background ==

			===Microbiology===
⚫	* ~~Typically involve a combination of ''Staphylococci'', ''Streptococci'',~~ Proteobacteria (Gram-negative bacterial genus that includes enterics)~~, and anaerobes~~
⚫	* Anaerobes are more likely to be involved in deeper, more chronic ulcers

			*Typically polymicrobial, including:
⚫	== Further Reading ==
			**[[Staphylococcus species]]
			**[[Streptococcus species]]
		⚫	**[[Proteobacteria]] (Gram-negative bacterial genus that includes enterics)
			**[[Anaerobes]]
		⚫	*Anaerobes are more likely to be involved in deeper, more chronic ulcers

			== Management ==
⚫	* [https://doi.org/10.2337/db12-0771 The Neuropathic Diabetic Foot Ulcer Microbiome IsAssociated With Clinical Factors]. ''Diabetes''. 2013;62:923-930.

			* Osteomyelitis
			** Traditionally, 6 weeks of parenteral therapy
			** May be able to shorten to 3 weeks based on more recent evidence[[CiteRef::gariani2020th]]

		⚫	==Further Reading==

		⚫	*[https://doi.org/10.2337/db12-0771 The Neuropathic Diabetic Foot Ulcer Microbiome IsAssociated With Clinical Factors]. ''Diabetes''. 2013;62:923-930.

	[[Category:Skin and soft tissue infections]]		[[Category:Skin and soft tissue infections]]