Diabetic foot infection: Difference between revisions
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*Typically polymicrobial, including: |
*Typically polymicrobial, including: |
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− | **[[Staphylococcus |
+ | **[[Staphylococcus aureus]], which is by far the most common cause of monomicrobial infections |
+ | **[[Coagulase-negative staphylococci]] |
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**[[Streptococcus species]] |
**[[Streptococcus species]] |
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+ | **[[ENterococcus species]] |
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− | **[[Proteobacteria]] (Gram-negative bacterial genus that includes enterics) |
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− | **[[ |
+ | **[[Enterobacteriaceae]] |
+ | **[[Pseudomonas aeruginosa]] |
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+ | **[[Anaerobes]], including [[Bacteroides fragilis]] |
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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 |
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==Management== |
==Management== |
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+ | {| class="wikitable" |
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+ | !Severity |
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+ | !Common Pathogens |
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+ | !Antibiotics |
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+ | !Notes |
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+ | |- |
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+ | | rowspan="7" |Mild |
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+ | | rowspan="5" |methicillin-susceptible [[Staphylococcus aureus]], [[Streptococcus species]] |
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+ | |[[dicloxacillin]] |
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+ | |qid dosing and very narrow-spectrum |
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+ | |- |
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+ | |[[clindamycin]] |
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+ | |active against MRSA but higher risk of [[CDAD]] |
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+ | |- |
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+ | |[[cephalexin]] |
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+ | |qid dosing |
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+ | |- |
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+ | |[[levofloxacin]] |
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+ | |not as effective against [[Staphylococcus aureus]] |
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+ | |- |
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+ | |[[amoxicillin-clavulanic acid]] |
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+ | |broad-spectrum, includes anaerobic coverage |
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+ | |- |
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+ | | rowspan="2" |methicillin-resistant [[Staphylococcus aureus]] |
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+ | |[[doxycycline]] |
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+ | |uncertain activity against streptococci |
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+ | |- |
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+ | |[[TMP-SMX]] |
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+ | |uncertain activity against streptococci |
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+ | |- |
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+ | | rowspan="13" |moderate or severe |
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+ | | rowspan="9" |[[MSSA]], [[Streptococcus species]], [[Enterobacteriaceae]], [[anaerobes]] |
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+ | |[[levofloxacin]] |
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+ | |suboptimal against MSSA |
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+ | |- |
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+ | |[[cefoxitin]] |
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+ | | |
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+ | |- |
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+ | |[[ceftriaxone]] |
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+ | | |
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+ | |- |
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+ | |[[ampicillin-sulbactam]] |
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+ | | |
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+ | |- |
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+ | |[[moxifloxacin]] |
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+ | | |
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+ | |- |
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+ | |[[ertapenem]] |
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+ | | |
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+ | |- |
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+ | |[[tigecycline]] |
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+ | | |
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+ | |- |
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+ | |[[Fluoroquinolones|fluoroquinolone]] with [[clindamycin]] |
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+ | | |
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+ | |- |
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+ | |[[imipenem-cilastatin]] |
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+ | | |
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+ | |- |
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+ | | rowspan="3" |MRSA |
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+ | |[[linezolid]] |
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+ | | |
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+ | |- |
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+ | |[[daptomycin]] |
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+ | | |
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+ | |- |
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+ | |[[vancomycin]] |
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+ | | |
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+ | |- |
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+ | |[[Pseudomonas aeruginosa]] |
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+ | |[[piperacillin-tazobactam]] |
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+ | | |
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+ | |} |
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*Osteomyelitis |
*Osteomyelitis |
Revision as of 16:19, 13 January 2021
Background
Microbiology
- Typically polymicrobial, including:
- Staphylococcus aureus, which is by far the most common cause of monomicrobial infections
- Coagulase-negative staphylococci
- Streptococcus species
- ENterococcus species
- Enterobacteriaceae
- Pseudomonas aeruginosa
- Anaerobes, including Bacteroides fragilis
- Anaerobes are more likely to be involved in deeper, more chronic ulcers
Management
Severity | Common Pathogens | Antibiotics | Notes |
---|---|---|---|
Mild | methicillin-susceptible Staphylococcus aureus, Streptococcus species | dicloxacillin | qid dosing and very narrow-spectrum |
clindamycin | active against MRSA but higher risk of CDAD | ||
cephalexin | qid dosing | ||
levofloxacin | not as effective against Staphylococcus aureus | ||
amoxicillin-clavulanic acid | broad-spectrum, includes anaerobic coverage | ||
methicillin-resistant Staphylococcus aureus | doxycycline | uncertain activity against streptococci | |
TMP-SMX | uncertain activity against streptococci | ||
moderate or severe | MSSA, Streptococcus species, Enterobacteriaceae, anaerobes | levofloxacin | suboptimal against MSSA |
cefoxitin | |||
ceftriaxone | |||
ampicillin-sulbactam | |||
moxifloxacin | |||
ertapenem | |||
tigecycline | |||
fluoroquinolone with clindamycin | |||
imipenem-cilastatin | |||
MRSA | linezolid | ||
daptomycin | |||
vancomycin | |||
Pseudomonas aeruginosa | piperacillin-tazobactam |
- Osteomyelitis
- Traditionally, 6 weeks of parenteral therapy
- May be able to shorten to 3 weeks if adequately debrided, based on more recent evidence1
Further Reading
- The Neuropathic Diabetic Foot Ulcer Microbiome IsAssociated With Clinical Factors. Diabetes. 2013;62:923-930.
References
- ^ Karim Gariani, Truong-Thanh Pham, Benjamin Kressmann, François R Jornayvaz, Giacomo Gastaldi, Dimitrios Stafylakis, Jacques Philippe, Benjamin A Lipsky, İlker Uçkay. Three versus six weeks of antibiotic therapy for diabetic foot osteomyelitis: A prospective, randomized, non-inferiority pilot trial. Clinical Infectious Diseases. 2020. doi:10.1093/cid/ciaa1758.