Diabetic Foot Infection
Diabetic Foot Infection is a topic covered in the Johns Hopkins ABX Guide.
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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.
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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.
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