Diabetic Foot Infection - #MEDSHED
Pathogenesis
Diabetes, vascular compromise, peripheral neuropathy, and impaired immune function = high risk of foot infection. Exacerbated by peripheral neuropathy. Severe complications include osteomyelitis and necrotizing fasciitis. 130,000 lower extremity amputations secondary to DFI in the US (2016).
Target Pathogens
50 - 80% of cases are polymicrobial
Gram positive: Staphylococcus sp (MRSA accounts for ~15%), Streptococci sp, and Enterococcus
Gram negative: Enterobacteriacae (Escheriscia, Proteus, Klebsiella etc), Pseudomonas
Anaerobes (~33%): Bacteroides sp, Prevotella sp
Antibiotics
Coverage for Gram positive (w/out MRSA), Gram negatives (+Pseudomonas), and anaerobes
Pipericillin-tazobactam
Cefepime*/metronidazole
Levofloxacin*/metronidazole
Meropenem
PLUS
Coverage for MRSA
Vancomycin
Daptomycin
Linezolid
*May consider ceftriaxone w/out concerns for Pseudomonas
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