Diabetic Foot Infection, Moderate

It is essential that cases of moderate diabetic foot infection are managed in conjunction with Podiatry and Micro/ID, +/- surgical review by Foot & Ankle or Vascular teams. An assessment of vascular sufficiency should be performed. Refer to OUH Acute Foot Pathway (Acute Foot Pathway)

If there are signs of systemic sepsis where the foot is felt to be the source of infection: See guideline Sepsis identification and management

Moderate diabetic foot infection is either:

1. Moderate foot infection - Non-limb threatening (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
• Local tenderness or pain
• Local warmth
• Purulent discharge

OR

 2. Moderate foot infection - Limb threatening (as above with the addition of any of the following):

• Evidence of rapidly spreading infection​
• No or poor response to oral antibiotics​
• Clinical suspicion of deep collection likely to need surgical drainage​
• Existing cultures with no oral antibiotic option​
• Wet gangrene

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.

If cultures confirm Pseudomonal infection, then see  Diabetic foot infection - Severe

Course length is based on clinical assessment:

• Minimum 7 days and up to 6 weeks for osteomyelitis (use oral antibiotics for prolonged treatment).
• Metronidazole should not be given for longer than 14 days.
• Review empirical treatment within 48-72 hours.
• Prompt switch to oral antibiotics should be encouraged when clinically appropriate. Tailor according to culture and sensitivity.