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 should obtain wound cultures to determine if any dangerous organisms such as MRSA are present.

In these discussions, we discuss each of the 7 essential skills that your diabetes treatment team must use in order to help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number three
3. Obtain wound cultures to determine if any dangerous organisms such as MRSA are present. Use appropriate culture techniques.

The primary reason that a person ends up with a diabetic foot amputation is because of a poor blood supply and uncontrolled infection. When ever a diabetic foot ulceration (open sore) develops, bacteria that is normally growing on the skin will live within the wound.

Doctors call this colonization. Colonization is what a normal process. Your entire skin is colonized with bacteria. In most instances, colonized bacteria do not cause harm or disease. The difference between colonization and infection is that one is a normal process and another causes harm.

One definition of infection is “to do well in internally endoparasitically as opposed to externally.” A parasite always lives at the expense of its host. When bacteria in an open wound on a diabetic foot begins to invade the tissue, rather than just living on the surface a diabetic foot infection begins.

In order to remove any infecting bacteria it is important to differentiate the organism causing the infection from other organisms that are normally growing on the skin and may not be causing any harm. The most reliable way to differentiate these two groups of bacteria is by obtaining a wound culture.

A wound culture is a process whereby a doctor obtains a sample of infectious material and places it in an artificial medium, where it will grow. The basic idea, is to take samples of the bacteria in the wound and transfer them to a petri dish and place them in an incubator. The bacteria will then start to grow.

If several samples of different antibiotics are placed with in the petri dish and marked, the bacteria will not grow, near the antibiotics to which they are susceptible. This is how doctors determine which antibiotics are likely to kill the bacteria and remove the infection from a diabetic foot.

In order to remove an infection, you must take the appropriate antibiotics. This can only be determined accurately with a culture.

Not only is it important to take a wound culture and make sure that a diabetic foot infection is being treated correctly, timing is also important. It takes a couple of days for cultures to determine which antibiotics are going to be effective. Because of this, most diabetics with an infected open sore will be started on antibiotics that are probably going to work. It is critical that the wound culture is taken before these antibiotics are given. Once antibiotics have been given, but when cultures become unreliable.

If the diabetic foot infection is not treated with the right antibiotics, they can take much longer to remove the infection. Most antibiotics are processed and removed from the bloodstream by the kidneys. Diabetics are at high risk for kidney damage. Often times when someone who is a diabetic takes antibiotics for a long period of time, they can damage the kidneys further. This can lead to complete renal failure, which places the patient on dialysis. A diabetic patient who has had kidney failure will die without dialysis to remove impurities from the blood.

This being the case is understandable why it is important to make sure that any antibiotics taken are going to the effective and only administered for the shortest period of time.

Whenever you go to the emergency room or see a doctor because you believe that you have an infected diabetic foot ulceration, you must insist that cultures are obtained before you start any antibiotics. This will help speed your healing, minimize the chances of any kidney damage, and reduce the risk that you will end up with a diabetic leg amputation.

Keep in mind that early treatment is key. If you believe that you are developing a diabetic foot infection, you should seek treatment immediately. No matter what time of day or night. You should call your treating physician and explain to them, what is happening so that treatment can begin right away.

This is why it is so important for everyone with diabetes to have a doctor that they feel they can call at any hour to discuss their concerns. In most cases, a short discussion can help you determine whether or not, you need to get out of bed and go to the emergency room or if this is a smaller issue, or if it can wait until the next day.

No issue is too small to discuss with your diabetes doctor. Diabetics are at extraordinary risk for having what seems like a minor problem end up as a life-changing amputation. Amputations are preventable.


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed many diabetic foot amputations, he believes that diabetic leg amputations result from a failing health care system and inadequate 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.