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“My heal sore keeps getting worse and now it looks like it has a hole in it.”
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History of Present Illness
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Kim is a 53-year-old female who has uncontrolled Type 2 DM, neuropathy, HTN, obesity, and depression. She presents to the emergency department with a chronic heel ulceration that is infected. She is afebrile and hemodynamically stable. Most recent antibiotic therapy for the osteomyelitis of the heel was completed one month ago and she was unable to follow up with podiatry.
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List the most likely pathogen(s) that is/are contributing to the diabetic foot infection.
Hint: Make sure to consider the patient’s past medical history. See Introduction and Epidemiology and Etiology in PPP
Describe what signs and symptoms you would expect this patient to have if the diagnosis is osteomyelitis.
Hint: See Clinical Presentation and Diagnosis in PPP
How does the neuropathy play a role in the risk of the infection? What is the key to preventing or slowing the progression of the neuropathy?
Hint: See Treatment in PPP
Compare and contrast how this diagnosis of osteomyelitis would be treated differently if it was acute infection.
Hint: See Clinical Presentation and Diagnosis in PPP
Select an appropriate empiric antibiotic therapy for Kim.
Hint: See Treatment and Table 77-1 in PPP
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What is the appropriate duration of therapy for the osteomyelitis? Is there any consideration for Kim to be on suppressive therapy?
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Hint: See Treatment in PPP
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Diabetic foot infection is a severe public health issue. It is estimated that 15% of people with diabetes will develop a foot ulceration. Of those 15%, 55% will have an infection within the year and 15% of those will require an amputation. Globally, diabetic foot ulcer prevalence was 6.3% and varied between countries. Belgium has the highest prevalence at 16% and Oceania had the lowest at 1.5%. North America has an estimated 13%.