Gen: Patient is in no acute distress. Wt 84 kg (185 lb); ht 5 ft 11 in. (180 cm) Chest: CTAB

CV: RRR. No murmurs/rubs/gallops Ext: 4-cm purulent, erythematous lesion present on the plantar aspect of the left foot proximal to the great toe. 1+ edema in the left foot; diminished sensation bilaterally

Labs: At previous visit 4 months ago: BUN 14 mg/dL (5.0 mmol/L), SCr 1.0 mg/dL (88.4 pmol/L), Glu 154 mg/dL (8.5 mmol/L), A1C 7.7%

The patient is diagnosed with a diabetic foot infection.

Explain the role of neuropathy, angiopathy, and immunopathy in the development of this patient's diabetic foot infection.

What are the best preventative strategies for diabetic foot infections, and complications such as LEA?

Antimicrobial therapy for this patient's infection should provide coverage for which microorganisms?

What antimicrobial therapy would you recommend? Include drug, dosage, route, interval, and duration of therapy.

How would you monitor your selected regimen for safety and efficacy?

How would your antimicrobial therapy change if this patient was experiencing fever, chills, blood glucose values in the 400s, and obvious deep tissue involvement?

Multiple antibiotic options exist for the treatment of diabetic wound infections. Table 73-6 provides both general treatment strategies and specific, though not all-inclusive, antibiotic recommendations. The duration of therapy correlates with infection severity. Antibiotics should be continued until the infection has resolved, but not necessarily until the ulcer has healed. Grade 2 infections generally require 7 to 14 days of therapy, whereas grade 3 to 4 necessitate treatment durations of 14 to 28 days. If osteomyelitis is present, treatment duration depends on whether infected and necrotic bone is surgically debrided. In the case of amputation, where all infected bone and tissue is removed, 2 to 5 days of therapy is sufficient. Residual infection, status-post surgical debridement, requires 2 to 6 weeks of antibiotic therapy. Without surgery, antibiotic therapy should continue for at least 12 weeks.34

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