USJ DFI 2023

Which of the following are true in regard to signs and symptoms of a DFI? (multiple correct answers)

• Local symptoms are erythema and pain in the foot

• Systemic signs of DFI would be evident by meeting at least 2 SIRS criteria

• Signs and symptoms will be augmented by peripheral neuropathy

• Low blood pressure is one of the four SIRS criteria

Which statements best describe colonization of a wound and infection of a wound? (2 correct answers)

• Bacterial colonization of wounds is a constant phenomenon that does not involve invasion and multiplication of bacteria, nor triggers an inflammatory response

• Bacterial colonization of wounds is not a constant phenomenon, and involves invasion and multiplication of bacteria, which triggers an inflammatory response

• Bacterial infection of wounds is a constant phenomenon that does not involve invasion and multiplication of bacteria, nor triggers an inflammatory response

• Bacterial infection of wounds is not a constant phenomenon, and involves invasion and multiplication of bacteria, which triggers an inflammatory response

Diabetes is related to two risk factors that predispose diabetic patients to DFIs: diabetic complications that cause mild immunosuppression (neutrophil dysfunction, impaired phagocytosis, impaired intracellular microbicidal function) and _________ _____________ (causes increased risk for rapidly progressive or necrotizing infection, similar to PAD).

The following are gram positive bacteria that can cause DFI and are correctly paired with an antibiotic that will adequately cover them. (multiple correct answers)

• MRSA (vancomycin)

• Pseudomonas aeruginosa (cefepime)

• GBS (cephalexin)

• MRSA (linezolid)

A 68M with PMHx of T2DM and HTN presents with a swollen foot that is painful to the touch. On physical exam the patient is noted to have purulent discharge coming from a wound on the sole of his foot. The erythema surrounding the wound extends 4 cm from the wound margin. An X-ray of the foot showed bone abnormalities suggestive of osteomyelitis. Based on the IWGDF/IDSA 2023 guidelines, how would this patient's DFI be classified?

• 2/Mild

• 3/Moderate

• 3O/Moderate

• 4O/Severe

A 43F with PMHx of T2DM and HTN presents with pain on the dorsum of his foot. On physical exam the patient is noted to have erythema surrounding a small superficial wound that extends 0.5 cm around the wound. There is no pain, tenderness or warmth. An X-ray of the foot showed no bone abnormalities. He is not meeting any SIRS criteria. Based on the IWGDF/IDSA 2023 guidelines, how would this patient's DFI be classified?

• 2/Mild

• 3O/Moderate

• 3/Moderate

• 1/Uninfected

There are two main types of DFI, SST DFI and diabetes related osteomyelitis. Within SST DFI, there are three subtypes, cellulitis, ulcer, and abscess. Abscesses are typically located on the ​ (a)   of the foot, and can be caused by minor penetrating trauma or extension of infection of a nail or web space of toes. A good method to prevent this type of DFI is to ​ (b)   , properly clean, disinfect, and use ​ (c)   therapy if infected.

• arch
• sole
• dorsum
• relieve pressure
• appropriate antimicrobial
• broad-spectrum antimicrobial
• hyperbaric oxygen therapy
• use topical honey
• use topical silver treatments

A 55M with PMHx of T2DM, hyperlipidemia, and HTN presents with a swollen foot that is painful to the touch. He has an allergy to sulfa antibiotics (hives). He has been having trouble walking and was recently admitted to a different hospital after receiving a course of vancomycin for a MRSA SSTI of his R leg. On physical exam the patient is noted to have erythema surrounding a wound on the dorsum of his R foot that extends 1.5 cm from the wound margin. An X-ray of the foot showed no bone abnormalities. He has no complicating factors and has not received antibiotics within the past 90 days. Based on the IWGDF/IDSA 2023 guidelines, what empiric treatment regimen would be best? (1 answer)

• TMP/SMX + linezolid

• cephalexin + linezolid

• TMP/SMX

• cephalexin + daptomycin

A 71F with PMHx of T2DM, previous MI, and PAD presents with a swollen foot that is painful to the touch. NKDA. On physical exam the patient is noted to have erythema surrounding a wound on the arch of the foot that extends 3 cm from the wound margin. A probe to bone test was negative. An X-ray of the foot showed no bone abnormalities, but an MRI showed gas formation under the skin near the wound. No MRSA risk factors, and meeting 3/4 SIRS criteria. Based on the IWGDF/IDSA 2023 guidelines (and specifically considering complicating features), what would the best regimen for empiric treatment be? (1 answer)

• cefepime + metronidazole

• amp/sulb + clindamycin 900 mg q8h

• levofloxacin + clindamycin 900 mg q8h

• vancomycin + metronidazole

The same 71F starts empiric treatment of amp/sulb + clindamycin 900 mg IV q8h. It is now three days later. Culture data has become available, and the patient is growing Streptococcus pyogenes from the foot wound. The bacteria is S to ampicillin, cefazolin, and ceftriaxone. Which of the following is the best targeted treatment for this patient?

• ampicillin + metronidazole

• ampicillin

• ceftriaxone

• vancomycin