From the Guidelines
For a diabetic foot wound with cellulitis that initially improved with IV antibiotics but is now worsening again, immediate medical attention is crucial to prevent further complications and potential amputation, and a new course of antibiotics, possibly broader-spectrum options, should be considered based on culture results and the patient's clinical response 1. The deterioration of the wound suggests possible antibiotic resistance, inadequate initial treatment, or development of complications like deep tissue infection or osteomyelitis.
- Key considerations for the new course of antibiotics include:
- The severity of the infection
- The likely etiologic agent(s)
- The patient's prior history of antibiotic-resistant infections
- The local prevalence of antibiotic-resistant strains
- The healthcare provider should:
- Obtain wound cultures before starting new antibiotics
- Reassess the wound with possible imaging (X-ray, MRI) to check for bone involvement
- Consider performing surgical debridement to remove infected tissue While awaiting medical care, it is essential to:
- Keep the wound clean
- Elevate the affected limb
- Monitor for fever or increasing pain
- Continue strict blood glucose control, as hyperglycemia impairs immune function and wound healing 1. Diabetic foot infections can progress rapidly, and prompt medical evaluation is essential when symptoms worsen after initial treatment, to prevent potential amputation and improve outcomes 1.
From the Research
Diabetic Foot Wound with Cellulitis
- A diabetic foot wound with cellulitis that has finished a 12-day course of IV antibiotics and is now getting worse again may require further evaluation and treatment 2.
- The patient's risk factors, such as the presence of foot ulcers greater than 2 cm, uncontrolled diabetes mellitus, poor vascular perfusion, and comorbid illness, should be considered when evaluating for a foot infection or osteomyelitis 2.
- Indicators of infection, including erythema, induration, tenderness, warmth, and drainage, should be assessed, and deep cultures obtained through aseptic procedures may help guide treatment 2.
Antibiotic Therapy
- Antibiotic therapy should cover commonly isolated organisms, such as Staphylococcus aureus and Streptococcus agalactiae, and reflect local resistance patterns, patient preference, and the severity of the foot infection 2, 3.
- Treatment duration is typically one to two weeks, but may be longer for slowly resolving infections or osteomyelitis 2.
- Piperacillin/tazobactam may be a suitable option for empiric antibiotic therapy, especially in cases where Gram-positive bacteria are prevalent 3, 4, 5.
Wound Care and Management
- Regular inspection, cleansing, and removal of surface debris, as well as elimination of pathogenic bacteria, are essential for promoting wound healing 6.
- Creating an appropriate environment to facilitate endogenous tissue regeneration is also crucial, and may involve the use of various applications and dressings 6.
- A multidisciplinary approach to care, including glycaemic control, promotion of healing, and wound management, is necessary for effective treatment of diabetic foot ulcers 6.