Essential Skill #6 of Your Diabetic Foot Team: Evaluate Cultures and Change Antibiotics to Fight Bacteria Causing the Infection

In these discussions, we cover each of seven critical skills that your diabetic foot treatment must possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number six:

6. Be prepared o evaluate the cultures and change the antibiotics to most effectively fight the bacteria causing the infection.

As explained in the discussions regarding Essential skill #3 (Obtain wound cultures to determine if any dangerous organisms such as MRSA are present and use appropriate culture techniques.) it is critical that you receive the antibiotics that will be the most effective at curing your infection by killing off the bacteria.

The world is filled with bacteria. In fact keeping your skin is covered in bacteria right now. But just because you have bacteria covering your skin does not mean you are in fact it. Doctors refer to the presence of normal bacteria on the skin or in the tissue as colonization. The difference between colonization and infection is that when there is an infection, the bacteria is growing rapidly and causing damage to the tissue. Rapidly growing bacteria producing damage to the tissue is what results in a diabetic foot infections and can lead to a diabetes related amputation.

There are a number of different types of bacteria which can be found in diabetic foot ulcerations and diabetic foot infections. This is why it is important to take wound culture is and determine exactly which bacteria is the one causing the infection. This helps the doctors determine which antibiotics will be the most affective.

For example, if the infection is caused by Staphylococcus aureus and antibiotic such as cephalexin (Keflex) will be highly effective. If however cultures determined that the Staphylococcus aureus is a drug-resistant strain such as methicillin-resistant Staphylococcus aureus (MRSA) then cephalexin (Keflex) will not be affective at all. In fact, giving Keflex as a treatment for an infection caused by MRSA can even make the infection worse.

When there is a great deal of infected material available, the doctors can obtain a sample of the infection and perform a Gram stain. This is a very simple way to get a good idea, of which class of drugs might be affected. Based on this test, your doctors will likely begin antibiotics based on an educated guess of which organism it will be. This is what is known is emperic antibiotic therapy.

But within 48 to 72 hours of obtaining the wound culture is, your doctors should be receiving more detailed information about the bacteria causing the diabetic foot infection. They should also be receiving information about which antibiotic drugs to the infection causing bacteria as well as any concerns of antibiotic resistance. Based on this information, your doctors will then prescribe the appropriate antibiotics.

In the rush of taking care of multiple patients in multiple facilities at the same time, it is easy for your doctors to miss out on this information, and not receive it as soon as it's available. However, it is critical that you are started on the very best antibiotics as soon as possible.

If you have a diabetic foot infections and have not heard from your doctor for several days after cultures were taken, you should call the office and follow-up with that doctor. Otherwise, the report from the lab. That explains the wound culture results may just be sitting in a pile waiting for the doctor's signature in their office.

Treating a diabetic foot infection is an active process that plays itself out over several days. Your diabetic foot treatment team needs to be continually evaluating and reevaluating your condition as well as all of the reports that are coming in over those initial several days in order for you to be able to get better and avoid a diabetic foot amputation.

Diabetic foot amputations are preventable. Preventing a diabetes foot or leg amputation requires diligence on both the patient and the diabetic foot treatment team. Whether surgery is needed or not, the evaluation of the effectiveness of your antibiotics each to be rapid and performed at regular intervals. If you have any concerns about whether or not, you might be responding to the antibiotics you are given, always contact your doctor immediately.

Diabetes amputations are preventable. Live long and enjoy an active life!



Dr. Christopher Segler is an award winning diabetic foot doctor. He believes diabetes related amputations are attributable to a failing health care system that neglects patient education. It is his passion to teach strategies that can empower diabetic patients and stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.

Your Diabetic Foot Treatment Team: Why they must evaluate the depth and character of the wound.

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment should possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number four
4. Evaluate the depth and character of the wound. (Perform a wound assessment that includes both staging/grading of infection and ischemia.)
Open sores on the feet of diabetic patients are very common. These of course are referred to as diabetic foot ulcerations. Not every diabetic foot ulcer will lead to an amputation. Having said that, most diabetic foot or amputations start as a diabetic foot ulcer.

Because of this, it is extremely important for you ta make sure your diabetic foot treatment team thoroughly evaluates any diabetic wound.

Anytime you have a serious medical condition, the first question is…how bad is it? For example if you have cancer, you want to know what stage of the cancer. The stage of the cancer will tell you the extent of the spread and likelihood that you will live or die.

In the same way, staging a diabetic foot ulcer can determine whether or not your foot will live or die. Determining the wound stage will help to determine whether or not you will need to be hospitalized, have intravenous antibiotics, surgery, or even an amputation.

Before describing the staging process, let me caution you as a patient. It is my long-held belief that medical school is a way for doctors to teach student doctors how to lose their ability to communicate with patients.

Classification systems are a very good example of this. In my residency (that had a heavy focus on diabetic foot training), my director understood this more than most. In our surgical conferences if a student or resident doctor mentioned a classification of any condition, Dr. Young would always demand that they explain exactly what that classification meant. This is a vital skill for clear communication. It shows that the doctor can know and explain what is really going on.

Many doctors lose disability. They become so familiar with the technical language and classification schemes, that they are simply unable to describe in simple terms what they see when they evaluate a wound, an illness or a condition.

So without giving you all the specifics about each of the different classification schemes, we will explain what the components are that need to be evaluated and why each is important.

The first component of a diabetic foot ulcer (open wound) classification system that should be evaluated by your treatment team is the size of the hole. It doesn’t really matter how big it is across your foot, but it doesn’t matter how deep. The skin on the foot is very thin and when a diabetic ulcer gets deeper, tendons, ligaments, and bone can become exposed and damaged or infected. Bones and joints that is clearly exposed to the external world through an open diabetic wound can only very rarely be saved.

Not surprisingly, as the wound becomes deeper. The condition is taken much more seriously. In general, skin will not just grow in and cover exposed tendons and ligaments, joints or bones. Action must be taken. In many cases this means surgery. A hope and a prayer is rarely enough.

Once your team has decided how deep it (and what tissues are exposed through the wound) they should next determined whether or not infection is present. This is usually not difficult. Any experience treatment team should be able to determine easily if the wind is infected or not. By definition, if your team cultures the wound, they believe that it is infected. See essential number three.

Next they should determine whether or not there is sufficient blood flow to heal the wound. Poor blood flow to an area is referred to by doctors as “ischemia.” You have to remember that any antibiotics are delivered to the foot through the bloodstream. If the blood flow is poor, the antibiotics can’t even get to the site where the battle is taking place. In addition, there is very little chance of the wound healing without good blood flow.

If the ischemia (or poor circulation) gets bad enough, gangrene can set in. Gangrene is nothing more than death of the tissue. It is often related to infection. Obviously is critical to your team and evaluates the blood flow to your feet whenever you have a diabetic foot wound.

If you have ischemia and an open sore on a single toe, and your treatment seem decides to amputate that toe, it is possible that the blood flow is so bad that the amputation site won't heal. This could create an even larger problem hole in your foot. It is a very basic tenant of diabetic foot surgery that the level of amputation must have sufficient blood flow to heal. Otherwise you may end up with each of your little piggy’s going to market one at a time.

By evaluating the depth of the wound ( including skin, tendon, joint, and bone involvement), presence or absence of infection, and presence or absence of ischemia, a much more realistic prognosis can be determined. All of these factors must be considered in order to determine whether or not the wound is likely to heal without hospitalization and/or surgery.


If you have a diabetic foot ulceration that is being treated without evaluating all of these factors, it might serve you well to seek a second opinion. You should also feel you have the liberty to ask your doctor whether or not you have an infection, any ischemia, or exposed tendon or bone. This is your right. Expect your doctor to explain what is going on.

Beware of doctors who feel you don’t deserve answers.

Diabetes is a complicated disease. Diabetic foot problem likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about amputations can certainly be frightening, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Amputations are preventable. Live long and enjoy life!


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.