IDSA diabetic foot infection guideline covers diagnosis and treatment

A new clinical practice guideline from the Infectious Diseases Society of America (IDSA) provides detailed instruction on diagnosis and treatment of diabetic foot infections.
The guideline notes that not all foot wounds in diabetic patients are infected. Infections should be diagnosed by the presence of at least two classic symptoms or signs of inflammation or purulent secretions, the IDSA said. Infections can then be classified into mild, moderate or severe. These classifications, along with vascular assessment, will help determine the need for hospitalization, surgery or amputation. Imaging is helpful in most cases, the guideline said, beginning with plain radiographs and progressing to magnetic resonance imaging if more information is needed.
Hospital admission is recommended for all patients with a severe infection, selected patients with a moderate infection with complicating features, patients unable to comply with outpatient treatment regimens, or patients who fail to improve on outpatient therapy. Before discharge, patients should be clinically stable; have any urgently needed surgery; achieve glycemic control; be able to manage outpatient self-care; and have a well-defined plan, an off-loading scheme, specific wound care instructions and planned follow-up.
For either in- or outpatient treatment, the guideline also provides instructions on culturing diabetic foot infections and prescribing antibiotics based on the results of cultures. Wounds with no evidence of infection do not require antibiotic therapy, and aerobic gram-positive cocci are the most common causative organisms of infections, the IDSA said.
Recommendations on how to diagnose and treat osteomyelitis are also included in the guideline. Multidisciplinary team care is recommended whenever possible, and the guideline includes advice on when to refer care to specialists. The appropriate use of surgical interventions (which are required for most diabetic foot infections) and best methods of wound care are also described in the guideline, which is presented as a series of questions and answers.
The guideline was published online May 22 by Clinical Infectious Diseases.