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The Strategy of Wound and Infection Control in

The document discusses strategies for wound and infection control in diabetic foot ulcers. It notes that foot ulcers and subsequent infections are a major health issue for diabetics, often resulting in amputation. Proper treatment involves debridement, glucose control, nutrition, wound care, and infection control. Diabetic foot infections are classified based on severity from none to mild, moderate, and severe, with increasing systemic impact. Treatment recommendations are provided based on this clinical classification, ranging from oral antibiotics for mild infections to parenteral antibiotics for severe infections.

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58 views21 pages

The Strategy of Wound and Infection Control in

The document discusses strategies for wound and infection control in diabetic foot ulcers. It notes that foot ulcers and subsequent infections are a major health issue for diabetics, often resulting in amputation. Proper treatment involves debridement, glucose control, nutrition, wound care, and infection control. Diabetic foot infections are classified based on severity from none to mild, moderate, and severe, with increasing systemic impact. Treatment recommendations are provided based on this clinical classification, ranging from oral antibiotics for mild infections to parenteral antibiotics for severe infections.

Uploaded by

zaltri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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The Strategy of wound and

infection control in Diabetic


foot ulcer
Haryo Aribowo
Dept Bedah FK UGM/SMF Bedah RSUP Dr. Sarjito
Yogyakarta
Problems
Healing

Infection
Replace
Lose
footwear
footwear
Off-
loading

Amputation
Wound
General epidemiology

 252 million diabetics worldwide


 Foot problems account for largest number of
hospital bed days
 1-4% develop foot ulcer annually, 25% in
lifetime
 45-75% of all lower extremity amputations
 85% of these preceded by foot ulcer
 Two-thirds of elderly patients undergoing
amputation
 Studies have shown less costs for saving a
limb cf. amputation
Pathophysiology:
Neuropathy

Motor Sensory Autonomic


Abnormal foot Loss of protective Reduced skin
biomechanics sensation compliance and
lubrication

Ulceration
Vascular
insufficiency Infection
Overview of Diabetic Foot Infections
7% of Population
Diabetic

15-25% Develop Foot Ulcer

40-80% Infected
(or suspected)

40% Mild 30-40% Moderate 20-30% Severe


Microbial complexity
Microbial burden
Clinical risk

Anaerobes

Aerobic Gram-negative rods

Gram positive cocci

Severity
1 2 3 4 Depth
Necrosis
Prior Rx
Treatment: myths

Treat uninfected ulcers to promote healing


Treat infected ulcers until the ulcer is healed
Treat all the organisms isolated from the
microbiological specimens
Hospitalise all infections
Give lots of intravenous therapy
Management of Diabetic foot ulcer

Glucoses control
Nutrition
Debridement/wound care
Infections control
DEBRIDEMENT
1. Surgical : Anaestetic and non anaestetic
Sharp debridement

2. Non surgical : biological agent and non


biological agent
Larva, enzyme, modern dressing
1. Autolitik : aktivasi enzim autolitik tubuh dg
meningkatkan kelembaban jaringan luka,
dg produk seperti hirogel, hidrokoloid.
2. Enzimatik: produk enzim luar.
3. Biological: dg larva lalat emas, atau
keong hitam.
4. Mechanical Gauze Debridement: dresing luka
yg sesuai.
Evaluating the Patient with a DFI

Patient
Systemic response : Fever, chills, sweats
Metabolic status : Hyperglycaemia,
electrolyte imbalance, hyperosmolality, renal
impairment
Cognitive function
Delirium, depression, dementia,
psychosis
Social situation
Support, self-neglect
· Limb/Foot
· Wound
Patient
Limb or Foot
Biomechanics
Vascular
Ischaemia
Venous insufficiency
Neuropathy
Infection
Wound
Size, depth
Necrosis, gangrene
Infection
Clinical Classification of Diabetic Foot Infection

Wound without purulence or other


evidence of inflammation

More than 2 of purulence,


erythema, pain, tenderness,
warmth or induration. Any
cellulitis/erythema extends ≤2 cm
around ulcer and infection is
limited to skin/superficial subcut
tissues. No local complications or
systemic illness
Infection in patient who is systemically well &
metabolically stable but has any of:
cellulitis extending >2 cm; lymphangitis;
spread beneath fascia; deep tissue
abscess; gangrene; muscle, tendon, joint
or bone involved

Infection in a patient with systemic toxicity


or metabolic instability
Outcomes DFI Severity Classification
100%

89%
90%

80%

70%

60%
54%

50%

40%

30%

20%

10%
10% 6%

0%
None
No infection Mild
Mild Moderate
Moderate Severe
Severe
Antibiotic
Agent(s) Mild Moderate Severe
Advised Route Oral for Most Oral or IV Parenteral
Dicloxacillin Yes
Clindamycin Yes
Cephalexin Yes
TMP/SMX Yes Yes
Amoxicillin/clavulanate Yes Yes
Levofloxacin Yes Yes
Cefoxitin Yes
Ceftriaxone Yes
Ampicillin/sulbactam Yes
Linezolid (± aztreonam) Yes
Daptomycin (± aztreonam) Yes
Ertapenem Yes
Cefuroxime (± metronidazole) Yes
Ticarcillin/clavulanate Yes
Piperacillin/tazobactam Yes Yes
Levo- or Cipro- floxacin + Clindamycin Yes Yes
Imipenem-cilastatin Yes
Vanco + Ceftazidime ± metronidazole Yes
TERIMA KASIH

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