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Infections in Patients with Diabetes Part 4 of 4

Infections in Patients with Diabetes Part 4 of 4. Kelsey Schultz PharmD Candidate 2013 Butler University. Necrotizing Infections. Group of very lethal infections with a high (20-50%) mortality rate Polymicrobial including S. aureus , anaerobes, and Group A streptococci Presentation:

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Infections in Patients with Diabetes Part 4 of 4

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  1. Infections in Patients with Diabetes Part 4 of 4 Kelsey Schultz PharmD Candidate 2013 Butler University

  2. Necrotizing Infections • Group of very lethal infections with a high (20-50%) mortality rate • Polymicrobial including S. aureus, anaerobes, and Group A streptococci • Presentation: • severe and constant pain, skin necrosis and blisters, gas in the soft tissue, systemic toxicity, and rapid spread despite antibiotics Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913. http://hardinmd.lib.uiowa.edu/dermatlas/necrotizing.html

  3. Necrotizing Fasciitis Treatment • Surgical debridement and drainage of all necrotic tissue • Empiric broad spectrum antibiotic therapy could include: • piperacillin/tazobactam 4.5g IV every 6 hours • clindamycin 600-900mg IV every 8 hours • vancomycin 15-20mg/kg IV every 12 hours • consideration of an anti-pseudomonal fluoroquinolone or aminoglycoside. Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7th Ed. McGraw-Hill; 2008:1899-1913.

  4. Prevention: Methods to Avoid Infections • Tight blood glucose control American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61. The American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus 2007. Endocr Pract. 2007;13:S3-S76.

  5. Prevention: Methods to Avoid Infections • Meeting cholesterol and blood pressure goals will prevent further microvascular and macrovascular complications: • LDL < 100mg/dL or <70mg/dL in patients with cardiovascular disease (MI, stroke) • Triglycerides < 150mg/dL • HDL > 40mg/dL in men and >50mg/dL in women • Blood pressure <130/80 mmHg American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61.

  6. Prevention: Methods to Avoid Infections • Proper foot care including: • Daily inspection and cleaning of feet • Wear comfortable shoes • Don’t walk barefoot or try to remove calluses/corns on your own • Avoid dry skin by moisturizing feet before bedtime American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61. http://www.umm.edu/patiented/articles/diabetic_foot_care_000207.htm

  7. Prevention: Provider Screening and Testing of Foot Care • Providers should assess the following information when providing foot care for patients with diabetes: • Pulse, temperature, color, skin integrity • Fungal growth (within web-spaces of feet especially) • Monofilament test • Tuning fork for sensitivity to vibration • Short distance walking observation to determine bone, joint, and muscle problems American Diabetes Association. Standard of Medical Care in Diabetes-2011. Diabetes Care. 2011;34:S11-S61.

  8. Prevention: Neuropathy Foot Exams • Monofilament test: • Monofilament is placed at right angle to the skin on the plantar side of the foot • Pressure is applied until the filament buckles • Patient is asked if pressure was felt • those with foot ulcers tend to have a higher pressure threshold than those without ulcers McCulloch DK. Evaluation of the diabetic foot. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012. http://www.aafp.org/afp/1998/0315/p1325.html

  9. Prevention: Patient Education • UTI prevention in women: • Have patients wipe from front to back to prevent bacteria from entering the urethra • Postcoital voiding and increased fluid intake may be beneficial • Hooton TM, Gupta K. Recurrent urinary tract infection in women. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA. 2012. http://www.umm.edu/imagepages/19094.htm

  10. Overview of Topics Covered • Reasons for increased infections and delayed wound healing • Common infections and their incidence • Complications from infections • Treatment strategies for infections and wounds • Methods to avoid and prevent infections

  11. Infections in Patients with Diabetes Kelsey Schultz PharmD Candidate 2013 Butler University

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