Diabetic foot infection

A 55-year-old man with type 2 diabetes presents with complaint of “foot infection.” He is noted to have foul-smelling and purulent drainage from a 10-cm left plantar ulcer with exposed bone. His temperature is 39.4°C (102.9°F) and blood pressure is 90/ 50 mm H g. The WBC count is 35,000 cells/ m3, and an x-ray indicates extensive osteomyelitis involving several metatarsal bones and gas within the soft tissue space in the lower leg.