Diabetic Foot Infection, Moderate (e.g. gangrene or deep tissue involvement)

Moderate diabetic foot infection is defined as:

Local foot infection (as indicated by 2 or more of the following) AND either more extensive cellulitis (more than 2cm) or penetration deeper than subcutaneous tissue, but in the absence of systemic inflammatory response syndrome (SIRS):

• local swelling or induration
• erythema (more than 2cm around ulcer)
• local tenderness or pain
• local warmth
• purulent discharge

It is essential that cases of diabetic foot infection are managed in conjunction with Podiatry, Orthopaedic Surgery and Micro/ ID. An assessment of vascular sufficiency should be performed.

Cases should be managed according to severity with either oral or intravenous medication. Prompt switch to oral is encouraged when clinically appropriate.

A wound sample should be taken prior to/as soon as possible after starting antibiotics.  Superficial swabs have limited diagnostic value, so preference should be made for a deep swab, collection of pus, tissue sample (by an appropriately trained clinician) or surgical cultures.

Review empirical treatment within 48-72 hours. Switch to oral antibiotics when able to eat and drink.

If cultures confirm Pseudomonal infection, then see  Diabetic foot infection, severe