Download Infection in foot of patient with diabetes

Infection in foot of patient with diabetes
Recommend
 Consult MO for any patient who is a diabetic and has a foot lesion / infection
 Early treatment with appropriate antibiotics and wound care may prevent the need for the patient
with diabetes to be evacuated, hospitalised and undergo an amputation
Background
 Foot infections in patients with diabetes are a serious complication and frequently leads to
amputation
 Precipitating causes of foot ulceration and infection include: friction in ill fitting shoes, untreated
or self treated callus, foot injuries, burns, corn plaster, nail infections, heel frictions when
immobile and foot deformities
Related topics:
Diabetes, page 332
 Osteomyelitis in foot of patient with diabetes, page 306
Chronic wounds, page 308
1.
May present with:

Patient with diabetes
 and foot injury / trauma, signs of infection - swollen, inflamed foot
 ulcer or wound on foot

Septicaemia
2.
Immediate management:

Early treatment of any lesion on the foot of a patient with diabetes
3.
Clinical assessment:

Obtain a complete patient history including

past episodes of foot infections

any surgical treatment patient may have received for foot infections, such as amputation

measures patient has taken to prevent or manage foot infection/s such as foot wear, managing
blood sugar levels, taking medications / insulin, caring for feet

current medications

Perform standard clinical observations

Collect bloods and MC&S for pathology

HbA1c, FBC, CRP (cold reactive protein), Urea, Creatinine and GFR, random venous BGL

wound swab - microscopy and culture (MC&S)

Perform physical examination

inspect all surfaces of the foot and conduct foot assessment
o check for skin pallor, discolouration, oedema
o ulcers, cracks between toes, callus or deformities
o describe size, location, depth of any lesion/s
o signs of infection if present – redness, swelling, warm, exudate – colour and odour
o assess pulses – dorsalis pedis and posterior tibial
o assess protective sensation using a monofilament

assess if lymph node involvement
SECTION 1.01
4. Management:

Consult MO if / for:

systemic toxicity present, metabolic instability, poor observance with therapy or wound care, or
poor home support, severe focal infection

limb threatening ischaemia (ie absent pedal pulses with one or more of the following: rest pain,
gangrene or ischaemic ulcer)

MRSA is cultured, antibiotic order

For severe cases or if systemically unwell consult MO who may advise:

blood cultures, IV cannula, IV antibiotics

evacuation and hospitalisation

Manage hyperglycaemia in consultation with MO and Diabetes team (if available). Insulin may be
required in the short term to control BGL

Ensure correct fitting footwear

Encourage rest and elevation of foot

If deep penetrating ulcer is present or lesion not healing consider Osteomyelitis
 an X - ray may be useful

Determine in consultation type of primary dressing (and secondary dressing where required) See
Chronic wounds

The most likely organisms to infect a superficial ulcer are staphylococci, streptococci and sometimes
anaerobes consult MO who will order:



for mild to moderate infection with no evidence of osteomyelitis or septic arthritis, use:
Amoxycillin/Clavulanate or Cephalexin plus Metronidazole and for patients hypersensitive to
penicillin: Ciprofloxacin plus Clindamycin.
If MRSA is suspected or cultured consult MO who will order Rifampicin 300mg bd plus Fucidic
Acid 500mg bd
Resources available at http://www.health.qld.gov.au/cpic/resources/diabetic_foot.asp
5.
Follow up:
 Review the patient daily initially to assess progress and change dressings
 Ensure feet are inspected at each visit
6.
Referral / Consultation:
 Consult MO on all occasions
 Refer to diabetes educator if available for education on preventing infections
 All presentations must be referred to the high risk foot service or other specialist team for
assessment, for pressure relief and long term management