Diabetic foot infections

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Diabetic foot infections

Common complication with potential serious consequences, being the most common cause of lower extremity amputations in those with diabetes

Infection classification scheme :
Grade 1:
• no symptoms or signs of infection
Grade 2:
• infection involving the skin and subcutaneous tissue only, with no involvement of deeper tissues and no systemic signs and symptoms. No other causes of an inflammatory response (eg gout, trauma, etc).
• at least two of the following manifestations are present;
o localised swelling or induration
o erythema >0.5-2cm around the ulcer
o local tenderness or pain
o local warmth
o purulent discharge
Grade 3:
• infection involving structures deeper than the skin and subcutaneous tissues (eg abscesses, osteomyelitis, septic arthritis, or necrotizing fasciitis
• erythema (cellulitis) extending >2cm around and ulcer in addition to one of the following: oedema, tenderness, heat, purulent discharge
Grade 4:
 Any foot infection with signs o a systemic inflammatory response syndrome, manifested by two or more of the following:
o Temperature <360C or >380C
o Heart rate >90 beats/min
o Respiratory rate >20 beats/min
o PaC02 <32 mmHg o White blood cell count >12 000 or <4000 cells/mm3 o >10% immature (band) forms

Osteomyelitis:
Acute or chronic infection of one that is often difficult to diagnose in the diabetic foot

Osteomyelitis at base of ulcer  difficult to heal ulcer

Diagnosis of osteomyelitis:
 clinical – consider present if bone is visible; clinical signs –
 systemic – ESR and c-reactive protein
 x-ray –
 scintigraphy –
 MRI –
 Bone biopsy – culture is most definitive diagnosis

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