Diabetes Foot Ulcer and Pressure Ulcer Flashcards
What are some conditions that can cause dysfunction to the following systems? HINT: Neuropathy; immunopathy and vasculopathy.
Neuropathy
1. Peripherally - altered pain response and decrease pain sensation
2. Autonomic: Increase dryness, cracks
3. Motor: Muscle imbalance
Vasculopathy
1. Early atherosclerosis
2. Peripheral vascular disease
Conditions can be worsened by hyperglycemia and hyperlipidemia
Immunopathy
- Impairment in immune response increase susceptibility to infection
Exacerbated by hyperglycemia
What is the pathogenesis behind diabetes foot ulcer?
Dysfunction of the 3 systems leads to ulcer/ wound formation. Bacteria colonized and penetrate the wound. Proliferation occurs and causes DFI.
Identify the common pathogens associated with DFI.
S.Aureus
Streptococcus spp.
When is Gram Negative bacilli prevalent in DFI?
Chronic wounds
Wounds previously treated with antibiotics
What are some anaerobes present in DFI? When are these anaerobes usually present?
Peptostreptococcus spp, Bacteroides spp.
Found in ischemic or necrotic wounds
Should I conduct a culture for all DFI?
No. Only those with moderate or severe DFI
What does the choice of antibiotics depend on for DFI?
Severity of infection based on classification
Patient specific factors such as allergies, MRSA risk and Pseudomonal risk factors
What is the severity classification for DFI and pressure ulcers?
Mild: Infection of skin and soft tissue, erythematous and < 2cm around ulcer, NO sign of systemic infection
Moderate: Infection of deeper tissue, erythematous, >2cm around ulcer, no sign of systemic infection
Severe: Infection of deeper tissue, erythematous, >2cm around ulcer, signs of systemic infection.
What are the pathogens associated with the various severity classification of DFI?
Mild: S.Aureus + Streptococcus spp
Moderate: S.Aureus + Streptococcus spp + Anaerobes + Gram Negatives (+/- Pseudomonas)
Severe: S.Aureus + Streptococcus spp + Anaerobes + Gram Negatives (+Pseudomonas)
What are the pathogens associated with the various severity classification of DFI?
Mild: S.Aureus + Streptococcus spp
Moderate: S.Aureus + Streptococcus spp + Anaerobes + Gram Negatives (+/- Pseudomonas)
Severe: S.Aureus + Streptococcus spp + Anaerobes + Gram Negatives + Pseudomonas
Select an antibiotic regimen for a patients with <2cm ulcer and no systemic signs of infection (no fever, RR normal, HR normal)
PO Antibiotics
- Cephalexin
- Cloxacillin
Select an antibiotic regimen for a patients with <2cm ulcer and no systemic signs of infection (no fever, RR normal, HR normal) but have allergy to beta lactams
PO Clindamycin 300-450mg BD
Select an antibiotic regimen for a patients with >2cm ulcer and no systemic signs of infection (no fever, RR normal, HR normal)
IV antibiotics
- Amoxicillin clavulanate 1.2g q6-8h
- Cefazolin 1-2g q8h/ Ceftriaxone + Metronidazole 500mg q8h
Select an antibiotic regimen for a patients with >2cm ulcer and has systemic signs of infection (fever, WBC count high, High HR)
IV antibiotics
- Piperacillin Tazobactam 4.5g q6-8h
- Cefepime 2g q8h + Metronidazole 500mg q8h
- Meropenem
Select an antibiotic regimen for a patients with <2cm ulcer and no systemic signs of infection (no fever, RR normal, HR normal) but has drug allergy to beta lactams
IV antibiotics : Ciprofloxacin + Clindamycin 600mg q6h
