Diabetic Foot Infection
Diabetic Foot Infection is a topic covered in the Johns Hopkins ABX Guide.
To view the entire topic, please sign in or purchase a subscription.
Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:
-- The first section of this topic is shown below --
PATHOGENS
- Most diabetic foot infections (DFIs) are polymicrobial; however, if the patient hasn’t recently received abx therapy, often monomicrobial and due to either staphylococcal or streptococcal infection.
- Frequent pathogens: most DFIs are polymicrobial.
- Initially, wounds usually with Gram-positive flora from the skin; as it becomes more chronic, tilts toward Gram negatives. Following broad-spectrum abx, flora may evolve to MRSA, VRE and more resistant Gram negatives.
- Aerobic Gram positive:
- Staphylococcus aureus
- Among the most commonly isolated pathogen in N. America and European series.
- Streptococcal spp.
- Especially GAS, GBS, group C or G streptococci
- Enterococcus spp.
- Coagulase-negative staphylococci usually a contaminant if obtained from a superficial swab, but should be viewed as authentic if obtained from deep tissue or bone.
- Staphylococcus aureus
- Aerobic Gram negative
- Enterobacteriaceae
- Pseudomonas aeruginosa (although frequently a commensal when found, studies using abx without antipseudomonal activity often yield similar results e.g., ertapenem v. piperacillin/tazobactam[18])
- Anaerobes, facultative anaerobes: usually when ulcers are deep, chronic and/or necrotic tissue is present.
- Superficial, early infections (cellulitis, cellulitis involving blisters and shallow ulcers) are typically caused by S. aureus or beta-hemolytic streptococci.
- Infections of ulcers that are chronic or previously treated with antibiotics may be caused by aerobic Gram-negative bacilli, S. aureus or Streptococci.
- Deep soft tissue infections, osteomyelitis, and gangrene are more often polymicrobial, including aerobic Gram-negative bacilli and anaerobes (anaerobic streptococci, Bacteroides fragilis group, Clostridium species), but Staphyloccocus aureus is also common as single pathogen.
- Multi-drug resistant Gram-negative organisms described in DFI especially ESBL, but most resistant organisms w/ reports from India and warmer climates.
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
PATHOGENS
- Most diabetic foot infections (DFIs) are polymicrobial; however, if the patient hasn’t recently received abx therapy, often monomicrobial and due to either staphylococcal or streptococcal infection.
- Frequent pathogens: most DFIs are polymicrobial.
- Initially, wounds usually with Gram-positive flora from the skin; as it becomes more chronic, tilts toward Gram negatives. Following broad-spectrum abx, flora may evolve to MRSA, VRE and more resistant Gram negatives.
- Aerobic Gram positive:
- Staphylococcus aureus
- Among the most commonly isolated pathogen in N. America and European series.
- Streptococcal spp.
- Especially GAS, GBS, group C or G streptococci
- Enterococcus spp.
- Coagulase-negative staphylococci usually a contaminant if obtained from a superficial swab, but should be viewed as authentic if obtained from deep tissue or bone.
- Staphylococcus aureus
- Aerobic Gram negative
- Enterobacteriaceae
- Pseudomonas aeruginosa (although frequently a commensal when found, studies using abx without antipseudomonal activity often yield similar results e.g., ertapenem v. piperacillin/tazobactam[18])
- Anaerobes, facultative anaerobes: usually when ulcers are deep, chronic and/or necrotic tissue is present.
- Superficial, early infections (cellulitis, cellulitis involving blisters and shallow ulcers) are typically caused by S. aureus or beta-hemolytic streptococci.
- Infections of ulcers that are chronic or previously treated with antibiotics may be caused by aerobic Gram-negative bacilli, S. aureus or Streptococci.
- Deep soft tissue infections, osteomyelitis, and gangrene are more often polymicrobial, including aerobic Gram-negative bacilli and anaerobes (anaerobic streptococci, Bacteroides fragilis group, Clostridium species), but Staphyloccocus aureus is also common as single pathogen.
- Multi-drug resistant Gram-negative organisms described in DFI especially ESBL, but most resistant organisms w/ reports from India and warmer climates.
There's more to see -- the rest of this entry is available only to subscribers.