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Questions and Answers
What are the two main ways to classify diabetic foot infections (DFIs)?
What are the two main ways to classify diabetic foot infections (DFIs)?
- Local changes and systemic inflammatory response syndrome (SIRS) (correct)
- Severity and bone involvement
- Local changes and bone involvement
- Severity and local changes
The Infectious Diseases Society of America/International Working Group on the Diabetic Foot (IDSA/IWGDF) classification scheme is generally not recommended for use by clinicians.
The Infectious Diseases Society of America/International Working Group on the Diabetic Foot (IDSA/IWGDF) classification scheme is generally not recommended for use by clinicians.
False (B)
Which of these is NOT one of the five major categories of clinical recommendations for managing DFIs?
Which of these is NOT one of the five major categories of clinical recommendations for managing DFIs?
- Microbiology
- Treatment (antibiotic, surgical, adjunctive)
- Diagnosis
- Management of comorbidities (correct)
What is the abbreviation for the most common precipitating event leading to lower extremity amputation in patients with diabetes?
What is the abbreviation for the most common precipitating event leading to lower extremity amputation in patients with diabetes?
Which of the following is the most widely used test for diagnosing bone infection in the diabetic foot?
Which of the following is the most widely used test for diagnosing bone infection in the diabetic foot?
When performing a bone biopsy for a possible osteomyelitis, it is preferred to obtain the specimen through the wound rather than percutaneously or during surgery.
When performing a bone biopsy for a possible osteomyelitis, it is preferred to obtain the specimen through the wound rather than percutaneously or during surgery.
What does NPWT stand for?
What does NPWT stand for?
The clinical evidence supporting the use of topical antimicrobial agents for treating diabetic foot infections is strong and compelling.
The clinical evidence supporting the use of topical antimicrobial agents for treating diabetic foot infections is strong and compelling.
What are the two main clinical criteria for diagnosing a soft tissue diabetic foot infection?
What are the two main clinical criteria for diagnosing a soft tissue diabetic foot infection?
Which of the following is NOT a potential indication for hospitalizing a person with diabetes who presents with a more complex foot infection?
Which of the following is NOT a potential indication for hospitalizing a person with diabetes who presents with a more complex foot infection?
The presence of bone infection in a diabetic foot always requires hospitalization.
The presence of bone infection in a diabetic foot always requires hospitalization.
Which of the following inflammatory serum biomarkers can be used to help diagnose a diabetic foot infection?
Which of the following inflammatory serum biomarkers can be used to help diagnose a diabetic foot infection?
Electronically measuring foot temperature is a useful method for diagnosing a diabetic foot infection.
Electronically measuring foot temperature is a useful method for diagnosing a diabetic foot infection.
What are the two main diagnostic tests to consider when a patient with diabetes has a suspected osteomyelitis of the foot?
What are the two main diagnostic tests to consider when a patient with diabetes has a suspected osteomyelitis of the foot?
If plain X-rays and clinical and laboratory findings are most compatible with osteomyelitis, obtaining an advanced imaging study is the recommended next step.
If plain X-rays and clinical and laboratory findings are most compatible with osteomyelitis, obtaining an advanced imaging study is the recommended next step.
A high rate of immature (band) forms on a white blood cell count is a strong sign of osteomyelitis in a diabetic foot.
A high rate of immature (band) forms on a white blood cell count is a strong sign of osteomyelitis in a diabetic foot.
Collecting a culture specimen from a soft tissue diabetic foot infection is recommended using a swab.
Collecting a culture specimen from a soft tissue diabetic foot infection is recommended using a swab.
Molecular microbiological techniques are generally considered superior to conventional culture methods in diagnosing diabetic foot infections.
Molecular microbiological techniques are generally considered superior to conventional culture methods in diagnosing diabetic foot infections.
Clinicians are recommended to always use local antibiotic therapy when treating a diabetic foot infection.
Clinicians are recommended to always use local antibiotic therapy when treating a diabetic foot infection.
What are the two major antibiotic drug classes most notably associated with a high rate of nausea?
What are the two major antibiotic drug classes most notably associated with a high rate of nausea?
Antibiotic therapy is recommended for all patients with a soft tissue diabetic foot infection.
Antibiotic therapy is recommended for all patients with a soft tissue diabetic foot infection.
What is the most commonly prescribed antibiotic for a diabetic foot infection?
What is the most commonly prescribed antibiotic for a diabetic foot infection?
Empiric antibiotic treatment aimed at Pseudomonas aeruginosa is usually recommended for diabetic foot infections in temperate climates.
Empiric antibiotic treatment aimed at Pseudomonas aeruginosa is usually recommended for diabetic foot infections in temperate climates.
Obligate anaerobes are rarely a cause of diabetic foot infections.
Obligate anaerobes are rarely a cause of diabetic foot infections.
Topical antiseptic therapy is generally recommended for treating mild or moderate diabetic foot infections.
Topical antiseptic therapy is generally recommended for treating mild or moderate diabetic foot infections.
Hyperbaric oxygen therapy (HBOT) is a proven effective treatment for diabetic foot infections.
Hyperbaric oxygen therapy (HBOT) is a proven effective treatment for diabetic foot infections.
Granulocyte colony stimulating factor treatment is generally recommended for diabetic foot infections.
Granulocyte colony stimulating factor treatment is generally recommended for diabetic foot infections.
Silver-containing dressings are generally recommended for treating diabetic foot infections.
Silver-containing dressings are generally recommended for treating diabetic foot infections.
Honey is a common and effective treatment option for diabetic foot infections.
Honey is a common and effective treatment option for diabetic foot infections.
Bacteriophages are a widely available and well-established treatment option for diabetic foot infections.
Bacteriophages are a widely available and well-established treatment option for diabetic foot infections.
Negative pressure wound therapy (NPWT) is recommended only for treating diabetic foot infections that are not clinically infected.
Negative pressure wound therapy (NPWT) is recommended only for treating diabetic foot infections that are not clinically infected.
Surgical resection of infected bone is always recommended for treating osteomyelitis.
Surgical resection of infected bone is always recommended for treating osteomyelitis.
A two-step approach for combined soft tissue and bone infection in diabetic foot ulcers is recommended to treat patients who do not require urgent surgery.
A two-step approach for combined soft tissue and bone infection in diabetic foot ulcers is recommended to treat patients who do not require urgent surgery.
Antibiotic therapy for osteomyelitis is recommended for a shorter duration than for soft tissue infections.
Antibiotic therapy for osteomyelitis is recommended for a shorter duration than for soft tissue infections.
Obtaining a bone biopsy at the stump of the resected bone is generally not recommended during surgery for diabetic foot osteomyelitis.
Obtaining a bone biopsy at the stump of the resected bone is generally not recommended during surgery for diabetic foot osteomyelitis.
Hyperbaric oxygen therapy, topical oxygen therapy, and negative pressure wound therapy are all recommended as adjunctive treatment for diabetic foot infections.
Hyperbaric oxygen therapy, topical oxygen therapy, and negative pressure wound therapy are all recommended as adjunctive treatment for diabetic foot infections.
G-CSF is a proven effective treatment for accelerating healing of the diabetic foot ulcer.
G-CSF is a proven effective treatment for accelerating healing of the diabetic foot ulcer.
Antibiotic therapy, surgical procedures, and adjunctive treatments are the only three viable approaches for managing diabetic foot infections.
Antibiotic therapy, surgical procedures, and adjunctive treatments are the only three viable approaches for managing diabetic foot infections.
The goal of treating diabetic foot infections is to completely eradicate the infection, eliminating any chance of recurrence.
The goal of treating diabetic foot infections is to completely eradicate the infection, eliminating any chance of recurrence.
What is the most frequent diabetic complication requiring hospitalization?
What is the most frequent diabetic complication requiring hospitalization?
Which of the following is NOT one of the systematic, evidence-based steps in managing DFIs?
Which of the following is NOT one of the systematic, evidence-based steps in managing DFIs?
DFIs usually begin with a break in the protective cutaneous envelope.
DFIs usually begin with a break in the protective cutaneous envelope.
Limb ischemia increases the risk of an ulcer becoming infected.
Limb ischemia increases the risk of an ulcer becoming infected.
Chronic hyperglycemia directly causes DFIs.
Chronic hyperglycemia directly causes DFIs.
The tendons within the compartments of the foot facilitate proximal spread of infection.
The tendons within the compartments of the foot facilitate proximal spread of infection.
Which of the following is NOT a systemic symptom of a diabetic foot infection (DFI)?
Which of the following is NOT a systemic symptom of a diabetic foot infection (DFI)?
An experienced consultant (or team) should optimally evaluate a patient with a severe DFI within 24 hours.
An experienced consultant (or team) should optimally evaluate a patient with a severe DFI within 24 hours.
The aim of the document is to provide guidelines for the diagnosis and treatment of foot infections in people with diabetes.
The aim of the document is to provide guidelines for the diagnosis and treatment of foot infections in people with diabetes.
The GRADE methodology is structured around clinical questions in the PICOP format.
The GRADE methodology is structured around clinical questions in the PICOP format.
What are the four components of the PICO-format?
What are the four components of the PICO-format?
What is the purpose of the IWGDF/IDSA classification scheme?
What is the purpose of the IWGDF/IDSA classification scheme?
The IWGDF/IDSA classification scheme requires more than just a clinical examination to classify the infection severity.
The IWGDF/IDSA classification scheme requires more than just a clinical examination to classify the infection severity.
The IWGDF/IDSA classification scheme only includes the presence or absence of 'infection'?
The IWGDF/IDSA classification scheme only includes the presence or absence of 'infection'?
What does the letter 'O' denote in the IWGDF/IDSA classification scheme?
What does the letter 'O' denote in the IWGDF/IDSA classification scheme?
What is the preferred method for diagnosing osteomyelitis according to Recommendation 5?
What is the preferred method for diagnosing osteomyelitis according to Recommendation 5?
Plain X-rays are always a reliable indicator of osteomyelitis.
Plain X-rays are always a reliable indicator of osteomyelitis.
MRI is the most widely used test for diagnosing osteomyelitis.
MRI is the most widely used test for diagnosing osteomyelitis.
MRI is less expensive than newer advanced imaging tests such as 18F-FDG-PET/CT or 99mTc- exametazime (HMPAO)-labeled leukocyte scintigraphy.
MRI is less expensive than newer advanced imaging tests such as 18F-FDG-PET/CT or 99mTc- exametazime (HMPAO)-labeled leukocyte scintigraphy.
One of the main reasons for collecting a bone biopsy is to determine the antibiotic susceptibility of the bacteria.
One of the main reasons for collecting a bone biopsy is to determine the antibiotic susceptibility of the bacteria.
According to the IWGDF, aseptic bone collection is not safe.
According to the IWGDF, aseptic bone collection is not safe.
The IWGDF recommends using molecular microbiology techniques for the first-line identification of pathogens for patients with diabetic foot infections.
The IWGDF recommends using molecular microbiology techniques for the first-line identification of pathogens for patients with diabetic foot infections.
Molecular microbiology techniques are preferred for diagnosing diabetic foot infections.
Molecular microbiology techniques are preferred for diagnosing diabetic foot infections.
The IWGDF recommends treating clinically uninfected diabetic foot ulcers with systemic or local antibiotic therapy to reduce the risk of infection or promote ulcer healing.
The IWGDF recommends treating clinically uninfected diabetic foot ulcers with systemic or local antibiotic therapy to reduce the risk of infection or promote ulcer healing.
Which of the following situations does not require the urgent consultation of a surgical specialist?
Which of the following situations does not require the urgent consultation of a surgical specialist?
The IWGDF recommends treating diabetic foot osteomyelitis with antibiotic therapy for no longer than 6 weeks.
The IWGDF recommends treating diabetic foot osteomyelitis with antibiotic therapy for no longer than 6 weeks.
The IWGDF suggests that antibiotic therapy should be administered intravenously for longer than for soft tissue infections.
The IWGDF suggests that antibiotic therapy should be administered intravenously for longer than for soft tissue infections.
The main finding of Recommendation 25 is that one-third to two-thirds of patients who have undergone resection of clinically uninfected bone post-surgery will have residual infection.
The main finding of Recommendation 25 is that one-third to two-thirds of patients who have undergone resection of clinically uninfected bone post-surgery will have residual infection.
What does the acronym "IWGDF" stand for?
What does the acronym "IWGDF" stand for?
What is the most important aspect of managing diabetic foot infections (DFIs)?
What is the most important aspect of managing diabetic foot infections (DFIs)?
A patient with diabetes and a severe foot infection should always be hospitalized.
A patient with diabetes and a severe foot infection should always be hospitalized.
Which of the following is NOT a factor to consider when selecting an antibiotic for a patient with a DFI?
Which of the following is NOT a factor to consider when selecting an antibiotic for a patient with a DFI?
What is the most common cause of a diabetic foot ulcer becoming infected?
What is the most common cause of a diabetic foot ulcer becoming infected?
What is the name of the classification scheme used to define the severity of a DFI?
What is the name of the classification scheme used to define the severity of a DFI?
Which of the following is NOT a potential complication of DFI?
Which of the following is NOT a potential complication of DFI?
What is the most important factor to consider when determining the duration of antibiotic therapy for a patient with DFI?
What is the most important factor to consider when determining the duration of antibiotic therapy for a patient with DFI?
Hyperbaric oxygen therapy (HBOT) is a proven and effective treatment for DFI.
Hyperbaric oxygen therapy (HBOT) is a proven and effective treatment for DFI.
Which of the following is NOT a reason to consider surgical treatment for a patient with DFI?
Which of the following is NOT a reason to consider surgical treatment for a patient with DFI?
The duration of antibiotic therapy for osteomyelitis is typically 4-6 weeks.
The duration of antibiotic therapy for osteomyelitis is typically 4-6 weeks.
What is the name of the gold standard diagnostic test for osteomyelitis?
What is the name of the gold standard diagnostic test for osteomyelitis?
It is always necessary to collect a bone specimen for culture during surgery for diabetic foot osteomyelitis.
It is always necessary to collect a bone specimen for culture during surgery for diabetic foot osteomyelitis.
Which of the following is NOT a potential complication of antibiotic therapy for DFI?
Which of the following is NOT a potential complication of antibiotic therapy for DFI?
What two classifications are used to diagnose diabetic foot ulcers?
What two classifications are used to diagnose diabetic foot ulcers?
The presence of bone infection does not require hospitalization unless it is accompanied by substantial soft tissue damage.
The presence of bone infection does not require hospitalization unless it is accompanied by substantial soft tissue damage.
Hyperbaric oxygen therapy (HBOT) is a proven and widely accepted treatment for diabetic foot ulcers.
Hyperbaric oxygen therapy (HBOT) is a proven and widely accepted treatment for diabetic foot ulcers.
In patients without a recent history of antibiotic therapy, which pathogens should be targeted for empiric treatment of a mild diabetic foot infection?
In patients without a recent history of antibiotic therapy, which pathogens should be targeted for empiric treatment of a mild diabetic foot infection?
Which of the following is NOT a characteristic of a more serious diabetic foot infection?
Which of the following is NOT a characteristic of a more serious diabetic foot infection?
What is the recommended duration for treating diabetic foot osteomyelitis with antibiotic therapy?
What is the recommended duration for treating diabetic foot osteomyelitis with antibiotic therapy?
Aseptic collection of bone specimens during surgery is recommended to maximize the accuracy of culture results.
Aseptic collection of bone specimens during surgery is recommended to maximize the accuracy of culture results.
The use of adjunctive granulocyte colony stimulating factor (G-CSF) has been proven to effectively improve healing in diabetic foot ulcers.
The use of adjunctive granulocyte colony stimulating factor (G-CSF) has been proven to effectively improve healing in diabetic foot ulcers.
The IWGDF/IDSA clinical classification scheme can accurately predict when an infection has resolved.
The IWGDF/IDSA clinical classification scheme can accurately predict when an infection has resolved.
What is the most widely recommended diagnostic test for diagnosing diabetic foot osteomyelitis?
What is the most widely recommended diagnostic test for diagnosing diabetic foot osteomyelitis?
Hyperbaric oxygen therapy (HBOT) has been shown to be beneficial in treating diabetic foot ulcers.
Hyperbaric oxygen therapy (HBOT) has been shown to be beneficial in treating diabetic foot ulcers.
The prevalence of diabetes has been steadily decreasing in the past decade.
The prevalence of diabetes has been steadily decreasing in the past decade.
The international working group on the diabetic foot (IWGDF) recommends using molecular microbiology techniques (instead of conventional culture) for the first-line identification of pathogens from samples in a patient with a diabetic foot infection.
The international working group on the diabetic foot (IWGDF) recommends using molecular microbiology techniques (instead of conventional culture) for the first-line identification of pathogens from samples in a patient with a diabetic foot infection.
The IWGDF guidelines for treating diabetic foot infections have remained largely unchanged since the first edition published in 2004.
The IWGDF guidelines for treating diabetic foot infections have remained largely unchanged since the first edition published in 2004.
A history of chronic hyperglycemia can predispose individuals to diabetic foot infections.
A history of chronic hyperglycemia can predispose individuals to diabetic foot infections.
The IWGDF recommends routinely using topical antiseptics, silver preparations, honey, bacteriophage therapy, or negative-pressure wound therapy to treat diabetic foot infections.
The IWGDF recommends routinely using topical antiseptics, silver preparations, honey, bacteriophage therapy, or negative-pressure wound therapy to treat diabetic foot infections.
C-reactive protein (CRP) levels have been found to be consistently higher in patients with infected diabetic foot ulcers than those with non-infected diabetic foot ulcers, even those without foot ulcers.
C-reactive protein (CRP) levels have been found to be consistently higher in patients with infected diabetic foot ulcers than those with non-infected diabetic foot ulcers, even those without foot ulcers.
The IWGDF recommends treating all persons with diabetes and a severe foot infection with intravenous antibiotic therapy initially.
The IWGDF recommends treating all persons with diabetes and a severe foot infection with intravenous antibiotic therapy initially.
The IWGDF recommends treating all persons with diabetes and a mild diabetic foot infection with topical antiseptics for improving healing.
The IWGDF recommends treating all persons with diabetes and a mild diabetic foot infection with topical antiseptics for improving healing.
The IWGDF recommends switching to oral antibiotic therapy after 5-7 days, if a patient with diabetic foot osteomyelitis is clinically improving, provided their infection is not extensive and they do not have any conditions precluding oral therapy.
The IWGDF recommends switching to oral antibiotic therapy after 5-7 days, if a patient with diabetic foot osteomyelitis is clinically improving, provided their infection is not extensive and they do not have any conditions precluding oral therapy.
The IWGDF recommends that non-surgeons treat patients with uncomplicated forefoot osteomyelitis without surgical intervention.
The IWGDF recommends that non-surgeons treat patients with uncomplicated forefoot osteomyelitis without surgical intervention.
Tigecycline has been shown to be clinically superior to ertapenem in treating diabetic foot infections.
Tigecycline has been shown to be clinically superior to ertapenem in treating diabetic foot infections.
The IWGDF recommends that patients with diabetic foot osteomyelitis be treated with antibiotic therapy for no longer than 6 weeks.
The IWGDF recommends that patients with diabetic foot osteomyelitis be treated with antibiotic therapy for no longer than 6 weeks.
In a patient with diabetic foot osteomyelitis, the IWGDF recommends obtaining a bone biopsy after surgical resection to assess the presence of residual bone infection.
In a patient with diabetic foot osteomyelitis, the IWGDF recommends obtaining a bone biopsy after surgical resection to assess the presence of residual bone infection.
Diabetic foot infections are the least common complication that requires hospitalization for people with diabetes.
Diabetic foot infections are the least common complication that requires hospitalization for people with diabetes.
The IWGDF recommends using the probe-to-bone (PTB) test as a primary method for diagnosing osteomyelitis in a person with diabetes.
The IWGDF recommends using the probe-to-bone (PTB) test as a primary method for diagnosing osteomyelitis in a person with diabetes.
The IWGDF recommends obtaining bone biopsies for all patients with a suspected diabetic foot infection.
The IWGDF recommends obtaining bone biopsies for all patients with a suspected diabetic foot infection.
The IWGDF recommends obtaining a specimen of wound tissue from almost all clinically infected ulcers to determine the causative pathogen.
The IWGDF recommends obtaining a specimen of wound tissue from almost all clinically infected ulcers to determine the causative pathogen.
The IWGDF recommends that non-surgeons should urgently consult with a surgical specialist in cases of moderate infection complicated by extensive gangrene or necrotizing infection.
The IWGDF recommends that non-surgeons should urgently consult with a surgical specialist in cases of moderate infection complicated by extensive gangrene or necrotizing infection.
The IWGDF recommends that in a person with diabetes and suspected osteomyelitis of the foot, if the clinical and laboratory findings are most compatible with osteomyelitis, no further imaging is necessary.
The IWGDF recommends that in a person with diabetes and suspected osteomyelitis of the foot, if the clinical and laboratory findings are most compatible with osteomyelitis, no further imaging is necessary.
The IWGDF recommends treating all persons with diabetes and a possible foot infection with antibiotic therapy even if they are clinically uninfected, to reduce the likelihood of developing infection or to improve healing.
The IWGDF recommends treating all persons with diabetes and a possible foot infection with antibiotic therapy even if they are clinically uninfected, to reduce the likelihood of developing infection or to improve healing.
The IWGDF recommends treating patients with a diabetic foot infection with which of the following? (Select all that apply.)
The IWGDF recommends treating patients with a diabetic foot infection with which of the following? (Select all that apply.)
Which of the following is one of the contributing factors that predisposes to diabetic foot infections?
Which of the following is one of the contributing factors that predisposes to diabetic foot infections?
The IWGDF recommends using which of the following to diagnose diabetic foot osteomyelitis? (Select all that apply.)
The IWGDF recommends using which of the following to diagnose diabetic foot osteomyelitis? (Select all that apply.)
What are the two main categories of adjunctive treatments for diabetic foot infections?
What are the two main categories of adjunctive treatments for diabetic foot infections?
According to the IWGDF, what is the most commonly used classification scheme for diagnosing diabetic foot infections?
According to the IWGDF, what is the most commonly used classification scheme for diagnosing diabetic foot infections?
In a person with diabetes who has experienced a diabetic foot infection, how long does the IWGDF recommend following up with the patient after the infection has resolved to assess for recurrence?
In a person with diabetes who has experienced a diabetic foot infection, how long does the IWGDF recommend following up with the patient after the infection has resolved to assess for recurrence?
What are the three main categories of treatment for diabetic foot infections?
What are the three main categories of treatment for diabetic foot infections?
List two reasons why the IWGDF recommends selecting an antibiotic agent that has the narrowest spectrum for treating diabetic foot infections?
List two reasons why the IWGDF recommends selecting an antibiotic agent that has the narrowest spectrum for treating diabetic foot infections?
What are the two main considerations for selecting an antibiotic agent for treating a diabetic foot infection?
What are the two main considerations for selecting an antibiotic agent for treating a diabetic foot infection?
Topical antimicrobial therapy is generally an effective treatment for mild diabetic foot infections.
Topical antimicrobial therapy is generally an effective treatment for mild diabetic foot infections.
What is the recommended duration for antibiotic therapy for a diabetic foot infection?
What is the recommended duration for antibiotic therapy for a diabetic foot infection?
What are the two primary pathogens that should be targeted for empiric antibiotic therapy in a person with a mild diabetic foot infection residing in a temperate climate without a recent history of antibiotics?
What are the two primary pathogens that should be targeted for empiric antibiotic therapy in a person with a mild diabetic foot infection residing in a temperate climate without a recent history of antibiotics?
In a patient with diabetes and a suspected forefoot osteomyelitis with no other indication for surgical treatment, what treatment approach is recommended?
In a patient with diabetes and a suspected forefoot osteomyelitis with no other indication for surgical treatment, what treatment approach is recommended?
Tigecycline is generally considered a suitable treatment option for diabetic foot infections.
Tigecycline is generally considered a suitable treatment option for diabetic foot infections.
Hyperbaric oxygen therapy has shown a strong benefit for healing diabetic foot ulcers.
Hyperbaric oxygen therapy has shown a strong benefit for healing diabetic foot ulcers.
Granulocyte colony stimulating factor treatment has proven to be an effective adjunctive therapy for treating diabetic foot infections.
Granulocyte colony stimulating factor treatment has proven to be an effective adjunctive therapy for treating diabetic foot infections.
Topical antiseptics are routinely recommended for treating diabetic foot infections.
Topical antiseptics are routinely recommended for treating diabetic foot infections.
When diagnosing a soft tissue diabetic foot infection, what are the two key assessment steps?
When diagnosing a soft tissue diabetic foot infection, what are the two key assessment steps?
What are the main factors considered when selecting an antibiotic agent for treating a diabetic foot infection?
What are the main factors considered when selecting an antibiotic agent for treating a diabetic foot infection?
Which of the following is the best initial route of antibiotic administration for a patient with a severe diabetic foot infection?
Which of the following is the best initial route of antibiotic administration for a patient with a severe diabetic foot infection?
Topical antimicrobial agents are strongly recommended for the treatment of mild diabetic foot infections.
Topical antimicrobial agents are strongly recommended for the treatment of mild diabetic foot infections.
What is the recommended duration of antibiotic therapy for a patient with a mild diabetic foot infection?
What is the recommended duration of antibiotic therapy for a patient with a mild diabetic foot infection?
What is the recommended duration of antibiotic therapy for a patient with a moderate diabetic foot infection?
What is the recommended duration of antibiotic therapy for a patient with a moderate diabetic foot infection?
Which of the following is NOT a common reason for hospitalizing a patient with a diabetic foot infection?
Which of the following is NOT a common reason for hospitalizing a patient with a diabetic foot infection?
What is the most useful diagnostic test for determining the presence of osteomyelitis in a patient with a diabetic foot infection?
What is the most useful diagnostic test for determining the presence of osteomyelitis in a patient with a diabetic foot infection?
In patients with diabetes and suspected osteomyelitis, obtaining a bone specimen for culture and/or histopathology is only recommended when making a definitive diagnosis is necessary for selecting treatment.
In patients with diabetes and suspected osteomyelitis, obtaining a bone specimen for culture and/or histopathology is only recommended when making a definitive diagnosis is necessary for selecting treatment.
Hyperbaric oxygen therapy (HBOT) is a widely recommended and universally effective treatment for diabetic foot infections.
Hyperbaric oxygen therapy (HBOT) is a widely recommended and universally effective treatment for diabetic foot infections.
Antibiotic therapy alone is often sufficient for the treatment of diabetic foot osteomyelitis.
Antibiotic therapy alone is often sufficient for the treatment of diabetic foot osteomyelitis.
The traditional recommended duration of treatment for diabetic foot osteomyelitis is 6 weeks.
The traditional recommended duration of treatment for diabetic foot osteomyelitis is 6 weeks.
Obtaining a biopsy of presumed uninfected residual bone during foot surgery is not considered useful to determine if further antibiotic therapy is needed.
Obtaining a biopsy of presumed uninfected residual bone during foot surgery is not considered useful to determine if further antibiotic therapy is needed.
Clinicians should routinely use topical antiseptics, silver preparations, honey, bacteriophage therapy, and negative-pressure wound therapy for the treatment of diabetic foot infections.
Clinicians should routinely use topical antiseptics, silver preparations, honey, bacteriophage therapy, and negative-pressure wound therapy for the treatment of diabetic foot infections.
Which of the following antibiotics is NOT generally recommended for the treatment of diabetic foot infections?
Which of the following antibiotics is NOT generally recommended for the treatment of diabetic foot infections?
Treating clinically uninfected diabetic foot ulcers with antibiotic therapy is generally recommended as a preventive measure.
Treating clinically uninfected diabetic foot ulcers with antibiotic therapy is generally recommended as a preventive measure.
Flashcards
Diabetic Foot Infection (DFI)
Diabetic Foot Infection (DFI)
An infection in the foot of a person with diabetes, characterized by local or systemic signs of inflammation, typically starting in an open wound.
Severity of DFI
Severity of DFI
Categorization of DFI based on the IWGDF/IDSA classification scheme considering local and systemic inflammation, with grades from 1 (uninfected) to 4 (severe).
Hospitalization for DFI
Hospitalization for DFI
Considered for patients with severe DFI, and moderate DFI with complexity or other health issues.
Inflammatory Serum Biomarker
Inflammatory Serum Biomarker
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Foot Temperature Measurement
Foot Temperature Measurement
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Quantitative Microbial Analysis
Quantitative Microbial Analysis
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Osteomyelitis
Osteomyelitis
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Probe-to-Bone Test
Probe-to-Bone Test
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Plain X-rays
Plain X-rays
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Advanced Imaging
Advanced Imaging
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Bone Biopsy
Bone Biopsy
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Wound Culture
Wound Culture
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Molecular Microbiology Techniques
Molecular Microbiology Techniques
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Antibiotic Selection
Antibiotic Selection
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Parenteral Antibiotic Therapy
Parenteral Antibiotic Therapy
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Oral Antibiotic Therapy
Oral Antibiotic Therapy
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Topical Antimicrobial Agents
Topical Antimicrobial Agents
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Duration of Antibiotic Therapy
Duration of Antibiotic Therapy
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Empiric Antibiotic Regimen
Empiric Antibiotic Regimen
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Surgical Consultation
Surgical Consultation
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Forefoot Osteomyelitis Treatment
Forefoot Osteomyelitis Treatment
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Diabetic Foot Osteomyelitis Treatment
Diabetic Foot Osteomyelitis Treatment
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Antibiotic Switching
Antibiotic Switching
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Surgical Bone Resection
Surgical Bone Resection
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Hyperbaric/Topical Oxygen Therapy
Hyperbaric/Topical Oxygen Therapy
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Adjunctive Treatments
Adjunctive Treatments
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What is diabetic foot infection?
What is diabetic foot infection?
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How is DFI classified?
How is DFI classified?
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When is hospitalization for DFI considered?
When is hospitalization for DFI considered?
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What are inflammatory serum biomarkers?
What are inflammatory serum biomarkers?
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Is foot temperature measurement useful for diagnosing DFI?
Is foot temperature measurement useful for diagnosing DFI?
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Is quantitative microbial analysis useful for diagnosing DFI?
Is quantitative microbial analysis useful for diagnosing DFI?
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What is osteomyelitis?
What is osteomyelitis?
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What is the probe-to-bone test?
What is the probe-to-bone test?
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What is the role of plain X-rays for suspected osteomyelitis?
What is the role of plain X-rays for suspected osteomyelitis?
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When are advanced imaging techniques for osteomyelitis considered?
When are advanced imaging techniques for osteomyelitis considered?
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What is a bone biopsy and why is it important?
What is a bone biopsy and why is it important?
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Why is wound culture important?
Why is wound culture important?
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Are molecular microbiology techniques used for initial DFI diagnosis?
Are molecular microbiology techniques used for initial DFI diagnosis?
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Explain antibiotic selection for DFI.
Explain antibiotic selection for DFI.
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What is parenteral antibiotic therapy?
What is parenteral antibiotic therapy?
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When is oral antibiotic therapy used for DFI?
When is oral antibiotic therapy used for DFI?
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Are topical antimicrobial agents used for mild DFI?
Are topical antimicrobial agents used for mild DFI?
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What is the typical duration of antibiotic therapy for DFI?
What is the typical duration of antibiotic therapy for DFI?
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What factors influence empiric antibiotic regimen?
What factors influence empiric antibiotic regimen?
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When is surgical consultation needed for DFI?
When is surgical consultation needed for DFI?
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Explain the treatment for uncomplicated forefoot osteomyelitis.
Explain the treatment for uncomplicated forefoot osteomyelitis.
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How long is treatment for diabetic foot osteomyelitis?
How long is treatment for diabetic foot osteomyelitis?
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What is the role of antibiotic switching in osteomyelitis?
What is the role of antibiotic switching in osteomyelitis?
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What is surgical bone resection?
What is surgical bone resection?
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Are hyperbaric/topical oxygen therapies recommended for DFI?
Are hyperbaric/topical oxygen therapies recommended for DFI?
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What are some adjunctive treatments NOT routinely recommended for DFI?
What are some adjunctive treatments NOT routinely recommended for DFI?
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IWGDF/IDSA Classification
IWGDF/IDSA Classification
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Inflammatory Biomarkers
Inflammatory Biomarkers
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Plain X-rays for Osteomyelitis
Plain X-rays for Osteomyelitis
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Advanced Imaging for Osteomyelitis
Advanced Imaging for Osteomyelitis
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Bone Biopsy for Osteomyelitis
Bone Biopsy for Osteomyelitis
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Antibiotic Selection for DFI
Antibiotic Selection for DFI
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Duration of Antibiotic Therapy for DFI
Duration of Antibiotic Therapy for DFI
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Surgical Consultation for DFI
Surgical Consultation for DFI
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Antibiotic Switching for Osteomyelitis
Antibiotic Switching for Osteomyelitis
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Hyperbaric/Topical Oxygen Therapy for DFI
Hyperbaric/Topical Oxygen Therapy for DFI
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Granulocyte Colony Stimulating Factor
Granulocyte Colony Stimulating Factor
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Topical Antiseptics for DFI
Topical Antiseptics for DFI
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Negative-Pressure Wound Therapy
Negative-Pressure Wound Therapy
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Local Signs of DFI
Local Signs of DFI
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Systemic Signs of DFI
Systemic Signs of DFI
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Osteomyelitis Affecting Treatment
Osteomyelitis Affecting Treatment
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Risk Factors For DFI
Risk Factors For DFI
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Importance of Early Intervention
Importance of Early Intervention
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DFI Classification
DFI Classification
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What are Inflammatory Biomarkers?
What are Inflammatory Biomarkers?
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Duration of DFI Treatment
Duration of DFI Treatment
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Antibiogram
Antibiogram
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CLSI
CLSI
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MIC
MIC
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What does 'susceptible' mean in an antibiogram?
What does 'susceptible' mean in an antibiogram?
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What does 'resistant' mean in an antibiogram?
What does 'resistant' mean in an antibiogram?
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Why are antibiograms important?
Why are antibiograms important?
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What are some factors that can influence an antibiogram?
What are some factors that can influence an antibiogram?
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Why is it important to know your hospital's antibiogram?
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What are some challenges with antibiograms?
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Why is it important to follow CLSI guidelines?
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What happens if CLSI recommendations aren't followed?
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How frequently should antibiograms be updated?
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How are antibiograms generated?
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How are antibiograms used in practice?
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What is the role of an infectious disease specialist?
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What are some ways antibiograms can change over time?
What are some ways antibiograms can change over time?
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What are some ways to reduce the spread of antibiotic resistance?
What are some ways to reduce the spread of antibiotic resistance?
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What is the impact of antibiotic resistance on healthcare?
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What does an antibiogram tell you?
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Why are antibiograms facility-specific?
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What can influence an antibiogram?
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Challenges with antibiograms
Challenges with antibiograms
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Why follow CLSI guidelines?
Why follow CLSI guidelines?
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Infectious Disease Specialist Role
Infectious Disease Specialist Role
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How can antibiograms change over time?
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Susceptible Bacteria
Susceptible Bacteria
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Resistant Bacteria
Resistant Bacteria
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Factors impacting antibiograms
Factors impacting antibiograms
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Why is knowing your hospital's antibiogram important?
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Impact of not following CLSI guidelines
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Antibiogram update frequency
Antibiogram update frequency
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Role of an infectious disease specialist
Role of an infectious disease specialist
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Factors changing antibiograms over time
Factors changing antibiograms over time
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Reducing antibiotic resistance spread
Reducing antibiotic resistance spread
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Impact of antibiotic resistance on healthcare
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Antibiogram takeaway
Antibiogram takeaway
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What is an antibiogram?
What is an antibiogram?
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What does 'MIC' stand for?
What does 'MIC' stand for?
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Study Notes
IWGDF Guideline on the Diagnosis and Treatment of Foot Infections in Diabetes
- Goal: Guideline provides recommendations for diagnosing and treating foot infections in people with diabetes.
- Scope: Part of the 2019 IWGDF Guidelines on the Prevention and Management of Diabetic Foot Disease.
- Emphasis: Clinical diagnosis, treatment selection, and supportive care.
List of Recommendations
- Diagnosis: Clinically diagnose soft tissue infections based on local and systemic inflammation signs. Classify infection severity using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme.
- Hospitalization: Consider hospitalizing patients with severe or moderate (complex) foot infections, along with those with relevant comorbidities.
- Biomarkers: Use C-reactive protein, erythrocyte sedimentation rate, or procalcitonin as adjunctive measures for possible infection when clinical exam is unclear.
- Imaging: Do not rely on measuring foot temperature or quantitative microbial analysis for diagnosis. Use combination of probe-to-bone test, erythrocyte sedimentation rate (or C-reactive protein and/or procalcitonin), and plain X-rays to diagnose osteomyelitis in suspected cases.
- Advanced Imaging: If osteomyelitis remains uncertain, consider advanced imaging (MRI, 18F-FDG-PET/CT, or leukocyte scintigraphy).
- Bone Culture: If definitive diagnosis or pathogen identification for treatment selection is necessary, obtain bone sample for culture and histopathology.
- Wound Culture: Obtain an appropriate specimen for culture from most clinically infected wounds to determine causative pathogen(s).
- Specimen Collection: Aseptically collect a tissue specimen via curettage or biopsy for soft tissue infections.
- Antibiotic Therapy: Use an effective antibiotic with a proven track record of efficacy and clinical benefit for the individual patient's situation. Penicillins, cephalosporins, carbapenems, metronidazole, clindamycin, linezolid, daptomycin, fluoroquinolones, and vancomycin are examples.
- Antibiotic Selection: Choosing antibiotics needs to consider pathogen, infection severity, potential adverse reactions, and cost.
Additional Recommendations
- Antibiotic Route: Initially administer parenteral antibiotics for severe infections. Switch to oral if clinical improvement and no oral therapy contraindications exist.
- Treatment Duration: Treat skin/soft tissue infections for 1 to 2 weeks; consider extending to 3-4 weeks for extensive infections or peripheral artery disease.
- Empiric Regimens: For mild infections (temperate climates), target empiric therapy at aerobic gram-positive bacteria. For moderate or severe infections (tropical, ischemic, or previous antibiotic use), include gram-negative coverage and potentially obligate anaerobes.
- Clinical Course: Re-evaluate the patient if infection signs persist for 4 weeks. Consider further diagnostic tests or alternative treatments.
- No Treatment for Clinically Uninfected Ulcers: Do not treat clinically uninfected wounds with systemic or topical antibiotics.
- Surgical Consultation: Urgent surgical consultation for severe infections or moderate infections with complicated comorbidities (e.g. extensive gangrene, necrotizing infection, deep abscess).
- Osteomyelitis Treatment Considerations: Favor non-surgical treatment in uncomplicated forefoot osteomyelitis. Use a combination of probe-to-bone test, erythrocyte sedimentation rate/C-reactive protein/procalcitonin, and plain X-rays as initial diagnostic steps. Use advanced imaging only if diagnosis remains uncertain. Collect bone sample for culture for definitive identification and appropriate treatment strategy.
- Antibiotic Duration Considerations: Treat osteomyelitis with duration of 1 to 6 weeks dependent on clinical response. If infection persists beyond 4 weeks consider re-evaluation, repeated cultures, additional imaging, or surgical options and switch to an oral agent only if clinically justified.
- Antibiotic Selection Criteria: Antibiotic selection needs to take into account the likely or proven pathogen, infection severity, infection location (e.g.., bone, tissue), patient factors (e.g., allergies, previous drug reactions), and cost/availability.
Diagnostic Factors
- Clinical Findings: Local and systemic signs of inflammation (swelling, redness, pain, warmth, tenderness).
- Symptoms: Fever, chills, hypotension, confusion, and volume depletion, and other systemic findings,
- Lab tests: Elevated inflammatory markers (ESR, CRP), leukocytosis, azotemia, and electrolyte abnormalities.
- Wound Appearance: Tissue penetration, extensive (>2 cm) ulcer, necrosis, gangrene, distal wound, and deep or slow healing.
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Description
This quiz covers the IWGDF guidelines for diagnosing and treating foot infections in individuals with diabetes. It emphasizes clinical diagnosis, treatment selection, and the importance of hospitalizing patients with severe infections. Test your knowledge on the recommendations and classifications relevant to diabetic foot management.
