This page includes following topics: SSTI DFI Non-healing Ulcer Prosthetic Joint Infection Native Bone / Joint Infection Skin Decolonization Recommendation
SSTI:
Pharmacology and the Treatment of Complicated Skin and Skin-Structure Infections NEJM 2014 Editorial 2012 IDSA Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections CID 2011 IDSA Clinical Practice Guidelines for the Rx of MRSA Infections in Adults and Children IDSA 2011 Cellulitis and Soft-Tissue Infections In the Clinic Annals 2009 Necrotizing Soft-Tissue Infection: Diagnosis and Management CID 2007 Trimethoprim-sulfamethoxazole has a poor activity against group A streptococci and may contribute to a high failure rate among patients with cellulitis. Antibiotics for surgical site infection DM and SSTI Diabetic Foot Infection (DFI): Classification (see below Table 2) of DFI (Mild / Mod / Severe or Imminent Limb - Threatening (see below Table 12) ) - 2/2 - Evaluate at 3 level - Patient as a whole, affected limb (Vascularity, Venous Congestion, Peripheral Neuropathy etc), and then the wound - Obtain Culture or tissue biopsy (see below Table 5, 9) - Antibiotic based on Clinical Severity (see below Table 6, 8, 7, 11)- Wound Debridement and wound care - consider Imaging Study (Xray, MRI if clinically indicated for evaluation of DFO) - Vascular and ID consultation if necessary Also, see below for Approach to DF Osteomyelitis: Table 10 Approach to Non-response or recurrence : Table 10 (under non-healing ulcer) Interpretation of ABI: Table 13 ![]() ![]() ![]() ![]() Skin and soft tissue and bone infections Additional References: Case Based Learning 54 yo M with DM, PAD, COPD, HTN, HLD is seen in the clinic for non-healing ulcer of Left 3rd metatarsal area 2 months duration. Patient initially received Clindamycin for 2 weeks. 1 month later patient had MRI done and did not have Osteomyelitis, and was prescribed Ciprofloxacin for 10 days. Patient has also had narrowing of the left anterior tibial artery, and had angioplasty with balloon dilatation. No stents were placed. Was started on ASA, Statin, and Cilastazole. Due to the concern of osteomyelitis, ESR and XR is done. ESR is 45 (1 months back it was 39). X-ray foot is negative for Osteo. What should you do next.
Ans: Initial plan was to do #4. Given some concern of Osteomyeltis, MRI was obtained, and it showed Osteomyeltis. Learning Lesson: Xray cannot rule out osteomyelitis. Likewise, ESR cannot be the best way to assess osteomyelitis. In an appropriate patient, with poor blood flow, and long standing non-healing ulcer, go for MRI. |