I NFECTIONS IN P ATIENTS WITH D IABETES P ART 4 OF 4 Kelsey Schultz PharmD Candidate 2013 Butler University N ECROTIZING I NFECTIONS Group of very lethal infections with a high (20-50%) mortality rate Polymicrobial including S. aureus, anaerobes, and Group A streptococci Presentation: severe and constant pain, skin necrosis and blisters, gas in the soft tissue, systemic toxicity, and rapid spread despite antibiotics Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7 th Ed. McGraw-Hill; 2008: N ECROTIZING F ASCIITIS T REATMENT Surgical debridement and drainage of all necrotic tissue Empiric broad spectrum antibiotic therapy could include: piperacillin/tazobactam 4.5g IV every 6 hours clindamycin mg IV every 8 hours vancomycin 15-20mg/kg IV every 12 hours consideration of an anti-pseudomonal fluoroquinolone or aminoglycoside. Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. Dipiro et al. Pharmacotherapy: A Pathophysiologic Approach, 7 th Ed. McGraw-Hill; 2008: P REVENTION : M ETHODS TO A VOID I NFECTIONS Tight blood glucose control Glycemic Measurement ADAAACE Average preprandial plasma glucose (mg/dL)