Loucks, Kristin

Title:
Case Study: a Diabetic Foot Infection Without Osteomyelitis

Abstract:
Diabetic foot infections affect approximately 1/3 of patients with diabetes and carry 2.5 times higher risk of death for these patients. Of those infections, 50% are considered severe infections leading to osteomyelitis and often resulting amputation. Diagnosis of diabetic foot infections can often be delayed by coexisting nerve damage which can obscure pain and temperature sensation.

Case description: A 63-year-old male with a history of uncontrolled type 2 diabetes, hypertension, hyperlipidemia, and obesity presented to Urgent Care for left foot pain after stepping on a nail through his shoe 5 days prior. He was started on Cephalexin 500mg PO three times/day x5 days. He presented to PCP for follow up 5 days later and was given Ceftriaxone 1g IM and his Cephalexin was increased to four times daily. Dose increase aligned treatment with guidelines. He returned to the clinic 2 days later: the exam was significantly worse and he was sent to the ER.

Emergency Department labs showed a leukocytosis, diabetic ketoacidosis, and uncontrolled diabetes. Imaging was negative for osteomyelitis. Wound cultures grew out enterococcus. The patient remained admitted for 2 weeks for wound management.

Discussion: This case illustrates the importance of early and aggressive antimicrobial therapy for diabetic foot infections. Successful treatment includes offloading of pressure, wound care, and appropriate antimicrobial therapy. Antimicrobial therapy is indicated for all diabetic foot infections; empiric agent choice is determined by the perceived severity of infection. This presentation reviews guidelines and recommendations for managing patients with diabetic foot infections.

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