Premium
MRSA and osteomyelitis of the foot in diabetes
Author(s) -
Game F.,
Jeffcoate W.
Publication year - 2004
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2004.1424-8.x
Subject(s) - medicine , foot (prosody) , diabetes mellitus , citation , unit (ring theory) , diabetic foot , family medicine , diabetic foot ulcer , library science , endocrinology , psychology , philosophy , linguistics , mathematics education , computer science
A 52-year-old man is referred to the diabetic clinic by his general practitioner (GP). He has a history of Type 2 diabetes diagnosed 8 years ago which is treated with a combination of Metformin and Gliclazide (last HbA1c 8.6%). He also has hypertension for which he takes aspirin and Ramipril. The referral is prompted by the presence of a foot ulcer that has failed to heal over an 8-week period. The patient has had repeated courses of Co-Fluampicil prescribed by the GP. The referral is accompanied by a wound swab result that demonstrates isolation of methicillin-resistant Staphylococcus aureus (MRSA). Clinically the patient is well. Both feet appear neuropathic and are insensate, while peripheral pulses are palpable. On the right foot there is an ulcer under the first metatarso-phalangeal joint with surrounding callus, this foot is 3° hotter than the left. After debridement bone is palpable at the base of the wound. • What is the immediate management plan? • What is the clinical relevance of the wound swab result? • Should the patient be started on antibiotics? If so, which antibiotics are appropriate? • What is the long-term management of MRSA in the diabetic foot?