An Evidence and Consensus Based Approach to Diabetic Foot Infection

Mary Bessesen, MD:

Hi, there. I'm Mary Bessesen. I'm an infectious disease specialist. I'm a professor of medicine at the University of Colorado and the section chief of infectious diseases at the Rocky Mountain Regional VA Medical Center. One that I see very commonly is in a patient admitted to hospital, people want to give the broadest spectrum antibiotic therapy even if the patient has no systemic signs of infection. While I understand the concern, this is a serious infection, we want to treat it well, we don't have to always be in a big hurry. It's more important to make a bacteriologic diagnosis if there's a question of osteomyelitis than it is to start therapy immediately on admission.

Now, of course, if the patient has systemic signs of infection, if they have fever, if they have sepsis, that's a different story, that needs to be treated promptly. But if we're treating an infected wound without systemic signs of infection, try to hold off, get your cultures, preferably deep bone cultures, and then you can start your empiric therapy while you wait for those results. Podiatrists do so many things that that's like asking me who my favorite child is. I think screening and education are really important. That doesn't necessarily need to be done by the podiatrist. It could be done by ancillary staff in the practice to get people with diabetes early on to start examining their feet carefully and picking up infection early, I think, is a critical piece. Keeping in mind the role of perfusion and making use of the whole multidisciplinary team is another really critical piece.