2012 IDSA Clinical Practice

Guideline for the Diagnosis

and Treatment of Diabetic
Foot Infections

V. RIZKE CIPTANINGTYAS
PPDS MIKROBIOLOGI KLINIK

Introduction
Foot infections serious problem in
persons with diabetes
Most Diabetic Foot Infection (DFI) :
polymicrobial
The most common causative organism :
aerobic Gram Positive Cocci (GPC)
staphylococci
Aerobic gram negative bacilli : copathogen in chronic infections or follow
antibiotic treatment
Obligate anaerob : co-pathogens in

Introduction (2)

Uninfected wounds do not require antibiotic

therapy

For infected wound : obtain a post-debridement

specimen for aerobic and anaerobic culture

Empiric antibiotic regimens must be based on

available clinical and epidemiologic data

Definitive therapy should be based on cultures

of infected tissue

Introduction (3)
antibiotic
therapy

targeted at GPC in many acutely

infected patients

Empiric

At

risk for infection with antibioticresistant organisms or with chronic,

previously
treated
or
severe
infections

require
broader
spectrum regimens

How to obtain specimen

for culture in DFI?

Uninfected wounds
collection for culture

no

specimen

Infected wounds obtained specimen for

culture prior to starting empiric antibiotic
therapy

Cultures may be unnecessary for a mild

infection and has not recently received
antibiotic therapy

 Specimen

for culture :

from deep tissue

after the wound has been cleansed and

debrided
avoid swab specimen especially of
inadequately debrided wounds

Antibiotic for DFI

wounds not be treated
with antibiotic
All infected wounds antibiotic
therapy
combined
with
appropriate
wound care
Uninfected

antibiotic regimen based on the

severity of the infection and the likely
etiologic agents

Empiric

Mild to moderate infection, have not recently

received antibiotic targeting aerobic GPC

Severe infections broad spectrum empiric
antibiotic therapy

therapy based on the results of

an appropriately obtained culture and AST
and clinical response to the empiric regimen

Definitive

Infection caused Pseudomonas aeruginosa

empiric therapy is usually unnecessary
except for patient with risk factors for
true infection with this organism

Risk factors /prior history of MRSA

infection /local prevalence of MRSA
colonization or infection is high/infection is
clinically severe consider empiric
therapy directed against MRSA

Risk factors for MRSA infection

Prior

long-term use of antibiotic

Inapproproate use of antibotic
Previous hospitalization
Long duration of wound
The presence of of osteomyelitis
Nasal carriage of MRSA

Bagaimana pola kuman pada

DFI di RSDK?
Dari data WHONET RSDK tahun 20112012,
didapatkan 185 isolat dari hasil kultur
DFI.

POLA KUMAN INFEKSI KAKI DIABETIK RSDK

40
35
30
25
20
15
10
5
0