Assess the patient
Comorbidities and psychosocial conditions
Check vital signs, temperature and blood sugar
Assess the ulcer
Ischemic, Neuro-osteoarthropathic or Neuropathic
SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area and Depth)
assess signs of infection purulence, hotness, redness, swelling or tenderness
a
Assess biochemical and radiological status
CBC, Electrolytes, Creatinine, Cardiac enzymes
Inflammatory Markers (CRP, ESR, WBCs, Procalcitonin)
Imaging (two View Foot X-RAY, Probe-to-Bone test, Chest X-RAY)
Sent tissue culture
Severe Infection
Deep tissues or bone infection
Extensive cellulitis (>2cm)
Mild Infection
Severe inflammation with necrosis or
gangrene
Assess Severity
of Infection
Assess need for admission
Severe Foot ischemia
Not meet criteria for
admission
Care of the ulcer (dressing,
debridement, offloading)
Initiate appropriate
antimicrobial regiment
Set up follow up visit
Presence of the following admission criteria:
Admit the patient
Acute onset or rapidly progressive course
Assess need for debridement or amputation
Fever, Dehydration, Hypotension or
confusion
Start empirical parental wide spectrum antimicrobial
regimen for at least one to two weeks if no bone
infection and up to 3 weeks if bone infection proved
Significant Metabolic abnormalities
Maintain adequate fluid volume
Highly elevated inflammatory markers
Monitor inflammatory markers
Presence of foreign body
Monitor electrolytes, sugar control, oxygen and
metabolic status
Require extensive debridement
Reassess in 2-7 days
NO IMPROVEMENT
Reassess the patient clinically at least once daily
Reassess need for debridement
Regular care of dressing
Reassess wound care
Check inflammatory markers trending
Check patient adherence
Consider repeat culture
NO IMPROVEMENT
Improved
Reassess need for surgical intervention
(abscess drainage, debridement,
amputation)
Further patient education
Change to oral antimicrobial
regimen
Consider Advanced imaging (MRI, Duplex,
CTA, MRA)
Regular follow up
Consider outpatient follow up
Consider vascular consultation
IMPROVED
De-escalate antimicrobial
regimen
Check culture results
Escalate antimicrobial regimen