Chapter 34: Infectious Diseases

ASYMPTOMATIC BACTERIURIA

Population

• Nonpregnant women.

Recommendations

IDSA 2019

• Do not treat asymptomatic bacteriuria with antibiotics.

• Only screen pregnant women and patients undergoing urologic procedures.

Source

• https://doi.org/10.1093/cid/ciy1121

COMMON COLD

Population

• Healthy adults (those without chronic lung disease or immunocompromising conditions).

Recommendation

Annals of Internal Medicine 2016

• Do not prescribe antibiotics for the common cold.

Source

• http://annals.org/aim/fullarticle/2481815/appropriate-antibiotic-use-acute-respiratory-tract-infection-adults-advice-high

Comment

1. Harm from antibiotics outweighs benefits, as all causes of common cold are viral.

DIABETIC FOOT INFECTIONS, INPATIENT MANAGEMENT

Population

• Hospitalized adults older than 18 y with diabetic foot problems.

Recommendations

IDF 2017

• Assess arterial perfusion and need for revascularization.

• Debride callus and necrotic tissue to fully visualize wound, measure depth and extent.

• Obtain cultures: tissue or bone specimen preferred; deep swab only after debriding wound.

• Obtain x-ray of all new diabetic foot infections. Obtain MRI if osteomyelitis suspected and plain film is not diagnostic.

• Request surgical consult for deep abscesses, compartment syndrome, and necrotizing soft tissue infection.

• Treat clinically infected wounds with antibiotics:

  • 1–2 wk for mild-to-moderate infections.

  • 3 wk for more serious skin and soft tissue infections.

  • 6 wk for osteomyelitis.

Source

• https://www.idf.org/e-library/guidelines/119-idf-clinical-practice-recommendations-on-diabetic-foot-2017.html

Comment

1. A deep space infection may have deceptively few superficial signs.

NICE 2016

• Every hospital should have a multidisciplinary foot care team to assess and treat any diabetic patient with foot problems.

• Every patient with a diabetic foot problem should undergo an assessment for:

  • Need for debridement, pressure off-loading.

  • Vascular inflow.

  • Infection of the foot.

  • Glycemic control.

  • Neuropathy.

• If diabetic foot infection is suspected, obtain culture (soft tissue or bone sample preferred, or deep swab after debriding wound).

• If osteomyelitis is suspected, obtain an x-ray; if x-ray is normal, obtain an MRI.

• Provide off-loading for diabetic foot ulcers.

• For mild diabetic foot infections, treat with empiric antibiotics that provide good coverage of gram-positive organisms.

• For moderate-to-severe diabetic foot infections, treat with empiric antibiotics that provide coverage of gram-positive, gram-negative, and anaerobic bacteria.

Source

• https://www.nice.org.uk/guidance/ng19

Comments

1. The diabetic foot care team should include:

   1. Diabetologist.

   2. Surgeon with expertise managing DM foot problems.

   3. DM nurse specialist.

   4. Podiatrist.

   5. Tissue viability nurse.

   6. Biomechanic and orthotic specialist.

2. Unless part of a clinical trial, do not treat diabetic foot ulcers with:

   1. Electrical stimulation therapy, autologous platelet-rich plasma gel, regenerative wound matrices, dalteparin,

   2. Growth factors,

   3. Hyperbaric oxygen therapy.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)