Enterococcal Coverage in Diabetic Foot Infections

👴 has a diabetic foot 🦶 infection requiring surgery. Operative cultures grow ESBL E. coli and E. faecalis. The E. coli is resistant to quinolones and TMP-SMX. Would you use ertapenem monotherapy for home antibiotics?

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Explanation: Older guidelines have suggested that Enterococcus spp can be ignored in polymicrobial cultures from diabetic foot infections, however, newer guidelines do not specifically address. The overall data to answer this clinical question is poor. Although success has been demonstrated with regimens excluding Enterococcus spp activity, it is unclear whether this practice results in comparable outcomes when activity is included. If enterococcal coverage is initially excluded, close follow-up and addition of enterococcal coverage may be needed.

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