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IOS 9 Exam 4
Diabetic Foot Infections
Question | Answer |
---|---|
Pathophysiology of Diabetic foot infection is | Due to Diabetic neuropathy loss of sensation, and PAD loss of blood flow, leads to altered immunity (druken Macrophages, leukocytes, neutrophils) leads to poor wound healing |
Clinical presentation of diabetic foot infection | Peripheral neuropathy but usually seek medical attention due to swelling or erythema in the foot. |
Diabetic foot Infections are usually | Polymicrobial: Staph Epidermis, Staph Aureus, Anaerobic (smell), Gram - (enterobacter, Klebsiella, proteus, pseudomonas) |
Mild diabetic foot infection presentation | Superficial ulceration <2cm, purulent dischargem No osteomyelitis, no systemic symptoms (fever, chills) |
Treatment of Mild foot infection | Amoxicillin/clau 500-750BID or Dicloxcillin 500mg PO QID, or PCN allergy Septra DS 1 PO BID for 1-2 weeks |
Moderate - Severe diabetic foot infection clinical presentation | Ulcerations to deep tissue wound, purulent discharge, cellulitis, systemic toxcity (fever, chills), mild/moderate necrosis, NO of osteomyelitis |
Treatment of moderate-severe diabetic foot infection | Pipercillin/tazobactam 4.5g IV q6hr, or Imipentem 500mg IV q8hr, or Cefotetan 2g IV q12hr, surgical drainage/excision, assess revascularization Treat 3-4 weeks |
Severe Diabetic foot infection presentation | Ulceration to deep tissue wound (bone), purulent discharge, cellulitis, osteomyelitis, systemic toxcity (fever, chills) with septic shock, Marked necrosis,gangrene, bacteremia |
Treatment of severe diabetic foot infection | Ampicillin/sulbactam 3g IV q6hr +/- aminoglycoside or Fluoroquinolone, surgical debreitment, drain, or amputation. Must control hyperglycemia and ketoacidosis, assess revascularization Treat>6weeks |
Regranex can be used for | Would healing wet to dry but only with depths <2cm |
Prevention of Diabetic foot infection (4) | Proper foot care-Avoid keratolytics, hygine, trauma, Appropiate footware, Stop smoking, Good glycemic control |