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lnfectious Disease Diabetic Foot Infections Diagnosis Mild infections do not extend deeper than the skin and subcutaneous tissues; may be associated with purulent discharge, warmth, tenderness, or swelling; and erythema is <2 cm beyond the ulcer. Moderate infections are associated with either: . erythema >2 cm around the ulcer o inf'ection deeper than the skin and subcutaneous tissues Severe infections are associated with systemic signs of infection (hypotension, confusion, vomiting, acidosis, severe hypergly cemia, AKI). Testing Cultures are obtained from deep tissue curettage or biopsy. Assess all patients for arterial insulflciency (using ABI). Obtain foot imaging for all new diabetic foot infections. Treatment Surgical consultation should be obtained to evaluate the need for debridement, resection, amputation, or revascularization STUDY TAET E: Treatment of Diabetic Foot lnfections Category of lnfection Empiric Antibiotic Seleaion Mild (nonpurulent) Oral cephalexin, dicloxacillin, amoxicillin-clavulanate, or clindamycin Mild (purulent and at risk for MRSA) Oral doxycycline or trimethoprim-sulfamethoxazole with a p-lactam Moderate or severe lV p-lactam/p-lactamase inhibitor combinations, carbapenems, or metronidazole plus a fluoroquinolone or third-generation cephalosporin in addition to an anti-MRSA agent (vancomycin, daptomycin, linezolid) Toxic Shock Syndrome Diagnosis Staphylococcal TSS is associated with tampon use, nasal packings, surgical wounds, skin ulcers, burns, catheters, and injection drug use as well as: . fever >38.9'C (102.0'F) . systolic blood pressure <90 mm Hg . diffuse macular rash with subsequent desquamation . involvement of >3 organ systems (GI, muscular, mucous membranes, kidney, liver, blood, CNS) Streptococcal TSS is associated with necrotizing fasciitis and: . isolation of group A B hemolytic streptococci . systolic pressure <90 mm Hg . two additional findings (AKI; elevated liver enz5,nnes; macular rash or soft tissue necrosis; coagulopathy, thrombocytopenia, DIC; ARDS) 225