- Up to 25% of diabetics develop infections, sometimes limbs amputated.
- Usually S. aureus, can be group B strep, enterococcus, proteus, E. coli, klebsiella, enterobacter, P. aeruginosa, bacteroides, peptostreptococcus
- Prevention is best.
Mild infections:
- No antibiotics in the past month, local only involving skin and subcutaneous tissue, no SIRs.
- No MRSA risk – dicloxacillin, clindamycin, cephalexin, fluoroquinolones, nafcillin
- MRSA risk factors – doxycyclin, Bactrim
- Pseudomonas – levofloxacin 750 mg PO for 7 days
Moderate to Severe:
- Erythema greater than 2, deeper than skin and subcutaneous tissue with or without SIRS.
- Amp/sulbactam, ertapenem, cefoxitin, moxi alone or cipro or levo PLUS clindamycin, tigecycline
- If P.aeruginosa (uncommon), use pip/tazo, ceftazidime, cefepime or carbapenem
- If risk for MRSA, vanc or linezolid or daptomycin
Treat for 1-2 weeks for moderate to severe infections. Extended duration for osteomyelitis. After amputation, continue 2-5 days.
Osteomyelitis:
Signs and symptoms – fever, chills, localized pain, tenderness, swelling
Treatment:
- Peds: cefazolin, nafcillin, oxacillin, clindamycin (MRSA resistance >10), vancomycin (if MRSA and clindamycin resistance >10)
- Adults: nafcillin, oxacillin, cefazolin, ceftriaxone, clindamycin, vancomycin
- Treat 4-6 weeks.
- Add rifampin for prosthetic joints.