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Diabetic Foot Infection — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesDiabetic Foot InfectionRACP Adult Medicine

A 55-year-old man with poorly controlled type 2 diabetes presents with a painful, swollen right foot. X-ray shows gas in the soft tissues and periosteal reaction of the second metatarsal. Temperature is 39.2°C and WCC is 22 × 10⁹/L. Deep wound swab grows mixed organisms including Staphylococcus aureus, Streptococcus species, and anaerobes. What is the most important aspect of management?

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Correct answer: C — Urgent surgical debridement

Gas in soft tissues with osteomyelitis and systemic sepsis in a diabetic foot constitutes a severe, limb-threatening infection requiring urgent surgical debridement as the critical first step. This cannot be managed with antibiotics alone. Empirical broad-spectrum antibiotics (e.g. piperacillin-tazobactam ± vancomycin) are necessary but secondary to source control. IDSA diabetic foot guidelines emphasise surgery as the priority.

Reference: eTG – 2025 – Antibiotic Guidelines; IWGDF – 2023 – Diabetic Foot Guidelines