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Gonçalves J, Guimarães AR, Ferreira HU, Ribeiro S, Moreno T, Borges-Canha M, Meira I, Menino J, Silva F, Pedro J, Neves N, Simão RS, Santos L, Queirós J. Microbiological characterization of neuropathic diabetic foot infection: a retrospective study at a Portuguese tertiary hospital. BMC Infect Dis 2024; 24:791. [PMID: 39107703 PMCID: PMC11305078 DOI: 10.1186/s12879-024-09677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
Diabetic foot infection imposes a significant burden and is the major cause of nontraumatic limb amputation. Adequate patient management with effective antibiotic therapy is crucial.This retrospective cohort study aimed to characterize the microbiology and resistance patterns of moderate to severe neuropathic diabetic foot infection in patients hospitalized at a tertiary referral hospital between January 2020 and June 2023. Deep tissue specimens from ulcers were collected for culture.Sixty inpatients were included (62% male, mean age 59.1 ± 11.5 years). Osteomyelitis was present in 90% of the patients. Among 102 microorganisms (average of 1.91 ± 1.25 pathogens per patient), 60.8% were gram-positive bacteria, 31.4% were gram-negative, 3.92% were anaerobic bacteria, and 3.92% were fungi. Staphylococcus aureus (19%) and Enterococcus faecium (17%) were the most common. Pseudomonas aeruginosa (8%) and bacteria of the Enterobacterales family (24%) accounted for all the isolated gram-negative bacteria. Sixteen percent of Staphylococcus aureus and 67% of coagulase-negative Staphylococci were resistant to methicillin. Resistance to ampicillin was found in 11% of Enterococci. All Pseudomonas aeruginosa isolates were sensitive to piperacillin-tazobactam, ceftazidime, or cefepime. Among the Enterobacterales, resistance rates were 35% for piperacillin-tazobactam, 38% for ceftazidime, 21% for cefepime, and 13% for carbapenems.Although the prevalence of methicillin-resistant staphylococci was lower than that in other studies, carbapenem resistance among gram-negative bacteria warrants attention. This study highlights the importance of understanding local epidemiology for effective diabetic foot infection management and resistance mitigation.
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Affiliation(s)
- Juliana Gonçalves
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - André Rodrigues Guimarães
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Helena Urbano Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Sara Ribeiro
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Telma Moreno
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Marta Borges-Canha
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Inês Meira
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - João Menino
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Fábia Silva
- Department of Orthopedic and Traumatology, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
| | - Nélia Neves
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Ricardo São Simão
- Department of Orthopedic and Traumatology, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Lurdes Santos
- Faculty of Medicine, Universidade Do Porto, Porto, 4200-319 Portugal
- Department of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
- Intensive Care Unit of Infectious Diseases, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde de São João, Porto, 4200-319 Portugal
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Qu YD, Ou SJ, Zhang W, Li JX, Xia CL, Yang Y, Liu JB, Ma YF, Jiang N, Wang YY, Chen B, Yu B, Qi Y, Xu CP. Microbiological profile of diabetic foot infections in China and worldwide: a 20-year systematic review. Front Endocrinol (Lausanne) 2024; 15:1368046. [PMID: 39010897 PMCID: PMC11247326 DOI: 10.3389/fendo.2024.1368046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Pathogens causing diabetic foot infections (DFIs) vary by region globally; however, knowledge of the causative organism is essential for effective empirical treatment. We aimed to determine the incidence and antibiotic susceptibility of DFI pathogens worldwide, focusing on Asia and China. Methods Through a comprehensive literature search, we identified published studies on organisms isolated from DFI wounds from January 2000 to December 2020. Results Based on our inclusion criteria, we analyzed 245 studies that cumulatively reported 38,744 patients and 41,427 isolated microorganisms. DFI pathogens varied according to time and region. Over time, the incidence of Gram-positive and Gram-negative aerobic bacteria have decreased and increased, respectively. America and Asia have the highest (62.74%) and lowest (44.82%) incidence of Gram-negative bacteria, respectively. Africa has the highest incidence (26.90%) of methicillin-resistant Staphylococcus aureus. Asia has the highest incidence (49.36%) of Gram-negative aerobic bacteria with species infection rates as follows: Escherichia coli, 10.77%; Enterobacter spp., 3.95%; and Pseudomonas aeruginosa, 11.08%, with higher local rates in China and Southeast Asia. Linezolid, vancomycin, and teicoplanin were the most active agents against Gram-positive aerobes, while imipenem and cefoperazone-sulbactam were the most active agents against Gram-negative aerobes. Discussion This systematic review showed that over 20 years, the pathogens causing DFIs varied considerably over time and region. This data may inform local clinical guidelines on empirical antibiotic therapy for DFI in China and globally. Regular large-scale epidemiological studies are necessary to identify trends in DFI pathogenic bacteria. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023447645.
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Affiliation(s)
- Yu-dun Qu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shuan-ji Ou
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei Zhang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jia-xuan Li
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chang-liang Xia
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yang Yang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jia-bao Liu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yun-fei Ma
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nan Jiang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye-yang Wang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bo Chen
- Endocrinology Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bin Yu
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Qi
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chang-peng Xu
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, China
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Da Silva J, Santos D, Vilaça M, Carvalho A, Carvalho R, Jesus Dantas MD, Pereira MG, Carvalho E. Impact of Psychological Distress on Physiological Indicators of Healing Prognosis in Patients with Chronic Diabetic Foot Ulcers: A Longitudinal Study. Adv Wound Care (New Rochelle) 2024; 13:308-321. [PMID: 37756373 DOI: 10.1089/wound.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- Jessica Da Silva
- PDBEB-Ph.D. Program in Experimental Biology and Biomedicine, Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Diana Santos
- PDBEB-Ph.D. Program in Experimental Biology and Biomedicine, Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Margarida Vilaça
- CIPsi-Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - André Carvalho
- Centro Hospitalar e Universitário de Santo António, E.P.E., Unidade de Pé Diabético, Porto, Portugal
| | - Rui Carvalho
- Centro Hospitalar e Universitário de Santo António, E.P.E., Unidade de Pé Diabético, Porto, Portugal
| | - Maria de Jesus Dantas
- Centro Hospitalar do Tâmega e Sousa, E.P.E., Clínica do Pé Diabético, Penafiel, Portugal
| | - M Graça Pereira
- CIPsi-Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - Eugénia Carvalho
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
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Yang S, Hu L, Zhao Y, Meng G, Xu S, Han R. Prevalence of multidrug-resistant bacterial infections in diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14864. [PMID: 38619084 PMCID: PMC11017433 DOI: 10.1111/iwj.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Multidrug-resistant (MDR) bacterial infections have become increasingly common in recent years due to the increased prevalence of diabetic foot ulcers (DFUs). We carried out a meta-analysis aimed at investigating the prevalence of MDR bacteria isolated from DFUs and analysing the risk factors for MDR bacterial infection in patients with DFUs. The PubMed/Medline, Web of Science, Embase, Cochrane Library, Ovid, Scopus, and ProQuest databases were searched for studies published up to November 2023 on the clinical outcomes of MDR bacteria in DFUs. The main outcome was the prevalence of MDR bacteria in DFUs. A total of 21 studies were included, representing 4885 patients from which 2633 MDR bacterial isolates were obtained. The prevalence of MDR bacteria in DFUs was 50.86% (95% confidence interval (CI): 41.92%-59.78%). The prevalence of MDR gram-positive bacteria (GPB) in DFUs was 19.81% (95% CI: 14.35%-25.91%), and the prevalence of MDR gram-negative bacteria (GNB) in DFUs was 32.84% (95% CI: 26.40%-39.62%). MDR Staphylococcus aureus (12.13% (95% CI: 8.79%-15.91%)) and MDR Enterococcus spp. (3.33% (95% CI: 1.92%-5.07%)) were the main MDR-GPB in DFUs. MDR Escherichia coli, MDR Pseudomonas aeruginosa, MDR Enterobacter spp., MDR Klebsiella pneumoniae, and MDR Proteus mirabilis were the main MDR-GNB in DFUs. The prevalence rates were 6.93% (95% CI: 5.15%-8.95%), 6.01% (95% CI: 4.03%-8.33%), 3.59% (95% CI: 0.42%-9.30%), 3.50% (95% CI: 2.31%-4.91%), and 3.27% (95% CI: 1.74%-5.21%), respectively. The clinical variables of diabetic foot ulcer patients infected with MDR bacteria and non-MDR bacteria in the included studies were analysed. The results showed that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization and previous use of antibacterial drugs were significantly different between the MDR bacterial group and the non-MDR bacterial group. We concluded that there is a high prevalence of MDR bacterial infections in DFUs. The prevalence of MDR-GNB was greater than that of MDR-GPB in DFUs. MDR S. aureus was the main MDR-GPB in DFUs, and MDR E. coli was the main MDR-GNB in DFUs. Our study also indicated that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization, and previous use of antibacterial drugs were associated with MDR bacterial infections in patients with DFUs.
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Affiliation(s)
- Shaoling Yang
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Liye Hu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Yue Zhao
- Department of OrthopaedicsThe Gucheng County Hospital of Hebei ProvinceGuchengChina
| | - Guangzhe Meng
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Sijia Xu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Rui Han
- Department of NeurologyThe First Affiliated Hospital of Hebei Medical UniversityShijiazhuangChina
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Deng L, Wang G, Ju S. Correlation between inflammatory factors, autophagy protein levels, and infection in granulation tissue of diabetic foot ulcer. Immun Inflamm Dis 2024; 12:e1233. [PMID: 38577990 PMCID: PMC10996373 DOI: 10.1002/iid3.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To observe the expression of inflammatory factors and autophagy-related proteins in granulation tissue of diabetic foot ulcer (DFU) patients and analyze their relationship with infection. METHODS This is a retrospective cohort study. One hundred and fifty-two patients with DFU in our hospital from July 2020 to March 2022 were selected as the DFU group, including 98 cases in infection stage group and 54 cases in infection control group. The patients were further graded as the mild (51 cases), the moderate (65 cases), and the severe infection group (36 cases) according to the Wagner grading criteria. Sixty-seven patients with foot burns during the same period were selected as the control group. The distribution of pathogenic bacteria on the ulcer surface was examined using fully automated bacterial analyzer. The expression of inflammatory factors (procalcitonin [PCT], tumor necrosis factor-α [TNF-α], and interleukin-6 [IL-6]) was valued by real-time fluorescence quantitative PCR (qRT-PCR). Protein expression was measured by immunohistochemistry (IHC). The correlation was analyzed by Pearson. RESULTS The surface infection of DFU patients was mostly induced by gram-negative and gram-positive bacteria, with Pseudomonas aeruginosa predominating among the Gram-negative bacteria and Staphylococcus aureus among the gram-positive bacteria. The infection stage group had higher content of PCT, TNF-α, and IL-6 and lower content of Beclin-1 and LC3 than the infection control group (p < .001). The levels of PCT, TNF-α, and IL-6 in the DFU patients with cardiovascular events were higher than those in the nonoccurrence group (p < .001). Glycated hemoglobin in patients with DFU was positively correlated with PCT, TNF-α, and IL-6 levels (p < .05), and negatively correlated with Beclin-1 and LC3 levels (p < .001). CONCLUSION P. aeruginosa and S. aureus were predominant bacterial in DFU infections. Inflammatory factor and autophagy protein expression were closely correlated with the degree of infection.
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Affiliation(s)
- Lijuan Deng
- Department of Peripheral Vascular, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Gang Wang
- Department of Peripheral Vascular, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Shang Ju
- Department of Peripheral Vascular, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
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Da Silva J, Leal EC, Carvalho E, Silva EA. Innovative Functional Biomaterials as Therapeutic Wound Dressings for Chronic Diabetic Foot Ulcers. Int J Mol Sci 2023; 24:9900. [PMID: 37373045 DOI: 10.3390/ijms24129900] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The imbalance of local and systemic factors in individuals with diabetes mellitus (DM) delays, or even interrupts, the highly complex and dynamic process of wound healing, leading to diabetic foot ulceration (DFU) in 15 to 25% of cases. DFU is the leading cause of non-traumatic amputations worldwide, posing a huge threat to the well-being of individuals with DM and the healthcare system. Moreover, despite all the latest efforts, the efficient management of DFUs still remains a clinical challenge, with limited success rates in treating severe infections. Biomaterial-based wound dressings have emerged as a therapeutic strategy with rising potential to handle the tricky macro and micro wound environments of individuals with DM. Indeed, biomaterials have long been related to unique versatility, biocompatibility, biodegradability, hydrophilicity, and wound healing properties, features that make them ideal candidates for therapeutic applications. Furthermore, biomaterials may be used as a local depot of biomolecules with anti-inflammatory, pro-angiogenic, and antimicrobial properties, further promoting adequate wound healing. Accordingly, this review aims to unravel the multiple functional properties of biomaterials as promising wound dressings for chronic wound healing, and to examine how these are currently being evaluated in research and clinical settings as cutting-edge wound dressings for DFU management.
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Affiliation(s)
- Jessica Da Silva
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- PDBEB-Ph.D. Programme in Experimental Biology and Biomedicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
- Department of Biomedical Engineering, Genome and Biomedical Sciences Facilities, UC Davis, 451 Health Sciences Dr., Davis, CA 95616, USA
| | - Ermelindo C Leal
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
| | - Eugénia Carvalho
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
| | - Eduardo A Silva
- Department of Biomedical Engineering, Genome and Biomedical Sciences Facilities, UC Davis, 451 Health Sciences Dr., Davis, CA 95616, USA
- Department of Chemistry, Bioscience, and Environmental Engineering, University of Stavanger, Kristine Bonnevies vei 22, 4021 Stavanger, Norway
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Dörr S, Holland-Letz AK, Weisser G, Chatzitomaris A, Lobmann R. Bacterial Diversity, Antibiotic Resistance, and the Risk of Lower Limb Amputation in Younger and Older Individuals With Diabetic Foot Infection. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2023; 22:63-71. [PMID: 33745353 DOI: 10.1177/1534734621992290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A diabetic foot infection (DFI) contributes to high mortality and morbidity in diabetics due to its often rapid progressive and intricately treatable infection. DFIs are usually a polymicrobial infection and characterizing the entire bacterial load is still challenging. Prompt and effective treatment of DFI is nevertheless mandatory to safe limbs and lives. It is therefore crucial to know the local pathogen spectrum and its antibiotic susceptibility. METHODS AND MATERIAL For a 12-month period, we investigated 353 individuals with infected diabetic foot ulcer, their bacterial diversity, and antimicrobial susceptibility at fist-time visit in a Diabetic Foot Care Center in southern Germany. RESULTS Cultures yielded 888 species, most of them gram-positive cocci (primary Staphylococcus aureus). The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriacae. Because the prevalence of multiresistant species was surprisingly low (0.9% of isolated strains), we suggest penicillins with β-lactamase inhibitor in case of gram-positive-dominated infection or piperacillin/tazobactam or rather carbapenems with equal efficacy when gram-negative species are involved.
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Affiliation(s)
- Stefan Dörr
- Stuttgart General Hospital, Stuttgart, Germany
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Aragón-Hernández C, Aragón-Hernández J, Rojas-Bonilla JM. Clinical Features, Inflammatory Markers, and Limb Salvage in Older Adults with Diabetes-Related Foot Infections. INT J LOW EXTR WOUND 2023:15347346231154472. [PMID: 36726311 DOI: 10.1177/15347346231154472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Little information exists about diabetic foot infections (DFIs) in older patients. We hypothesize that older patients with DFIs have different clinical features and worse outcomes than younger patients. We conducted a prospective observational study consisting of a cohort of patients with diabetes and moderate to severe DFIs. Patients included in the cohort were dichotomized into two groups using percentile 75 (P75) of age as the cut-off value. Patients aged > P75 presented with more comorbidities and foot-related complications, a higher rate of peripheral arterial disease (PAD), worse renal function (higher values of blood urea nitrogen and creatinine, and lower values of estimated glomerular filtration rate), and lower values of HbA1c compared with younger patients. Infection severity, microbiological features, and inflammatory markers were similar in both groups. In the multivariate analysis, minor amputations were associated with age > P75 (OR = 2.8, 95% CI 1.3-5.9, p <0.01), necrosis (OR = 4.2, 95% CI 1.8-10.1, p < 0.01), and CRP values (OR = 1.045, 95% CI 1.018-1.073, p < 0.01). Major amputations were associated with a history of amputation (OR = 4.7, 95% CI 1.3-16.7, p = 0.01), PAD (OR = 4.3, 95% CI 1.2-14.6, p = 0.01), and albumin values (OR = 0.344, 95% CI 0.130-0.913, p = 0.03). In conclusion, limb salvage can be achieved in older patients with diabetes-related foot infections at the same rate as in younger patients, despite the fact that they have more comorbidities and foot-related complications, a higher rate of PAD, and worse renal function.
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Affiliation(s)
- Javier Aragón-Sánchez
- Department of Surgery, Diabetic Foot Unit, 222000La Paloma Hospital, Las Palmas de Gran Canaria, Spain
| | - Gerardo Víquez-Molina
- Diabetic foot Unit, San Juan de Dios 118003Hospital, San José de Costa Rica, Costa Rica
| | | | | | - Javier Aragón-Hernández
- Department of Surgery, Diabetic Foot Unit, 222000La Paloma Hospital, Las Palmas de Gran Canaria, Spain
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Liu W, Song L, Sun W, Fang W, Wang C. Distribution of microbes and antimicrobial susceptibility in patients with diabetic foot infections in South China. Front Endocrinol (Lausanne) 2023; 14:1113622. [PMID: 36761201 PMCID: PMC9904418 DOI: 10.3389/fendo.2023.1113622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To investigate the distribution of microbes and drug susceptibility in patients with diabetic foot infections (DFI) and provide guidance for clinical empirical treatment and the rational selection of antibacterial drugs. METHODS Retrospective analysis of the pathogenic bacterium distribution and antimicrobial susceptibility isolated from 581 DFI patients with different Wagner grades. RESULTS The 534 positive samples included 473 cases (88.58%)) of monomicrobial infections and 61 cases (11.42%) of polymicrobial infections before antibiotic therapy. A total of 656 strains were cultivated, including 387 (58.99%) strains of gram-positive organisms (GPOs), 235 (35.82%) gram-negative bacilli (GNB), and 21 (3.20%) fungal strains. Polymicrobial infections mainly occurred in patients with Wagner grade 3-4 ulcers. GPOs were predominant in Wagner grades 1-3 (grade 1: 96.67%, grade 2: 76.52%, grade 3 62.81%), and the most common was Staphylococcus aureus (grade 1: 31.66%, grade 2: 33.04%, grade 3 35.53%). GNB were predominant in grades 4-5 (grade 4: 51.46%, grade 5:60%), and the most common GNB in Wagner grades 4-5 was Proteus (grade 4:27.88%, grade 5: 42.86%), while the most common GPO was Enterococcus (grade 4:34.48%, grade 5:25.00%). Staphylococcus (including MRSA) and Enterococcus were still highly sensitive to vancomycin, linezolid, and tigecycline. Most GNB were still highly sensitive to meropenem, tigecycline, ertapenem, and amikacin. Proteus was most sensitive to amikacin (97.14%), followed by meropenem (92%) and ertapenem (80%). CONCLUSION The distribution of microbes and antimicrobial susceptibility in DFI patients varied with different Wagner grades. The most appropriate antimicrobial therapy should be selected based on the pathogen culture and antimicrobial susceptibility.
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Affiliation(s)
| | | | | | - Weijin Fang
- *Correspondence: Weijin Fang, ; Chun Jiang Wang,
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Ramsey DJ, Kwan JT, Sharma A. Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity. World J Diabetes 2022; 13:1035-1048. [PMID: 36578874 PMCID: PMC9791566 DOI: 10.4239/wjd.v13.i12.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.
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Affiliation(s)
- David J Ramsey
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - James T Kwan
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Arjun Sharma
- Department of Ophthalmology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, United States
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Luo Y, Niu S, Mai L, Liu X, Yang C. Factors Associated with Infection Severity of Diabetic Foot Ulcers: A Cross-Sectional Study. INT J LOW EXTR WOUND 2022:15347346221140164. [PMID: 36412012 DOI: 10.1177/15347346221140164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background: Infection in the ulcerated foot is a foremost cause of morbidity, constituting the biggest proportion of hospitalization and amputation among patients with diabetic foot ulcers. Assessment of infection severity lays a foundation for making treatment decisions, for which the IDSA/IWGDF classification is recommended. Different factors may cause various severity of infection. However, few investigations have been conducted concerning factors associated with infection severity of diabetic foot ulcers. Objective: To investigate factors associated with infection severity of diabetic foot ulcers. Methods: This cross-sectional study involved 150 subjects hospitalized in the Department of Endocrinology of Sun Yat-sen Memorial Hospital in Guangdong Province between July 2020 and September 2021. The IDSA/IWGDF classification was adopted to assess ulcer infection severity. Demographic and disease information, laboratory reports, and ulcer assessment results were evaluated for an association with the infection severity. The generalized linear model was performed to conduct multivariate analyses of the factors associated with the severity of foot infection. Results: The prevalence of mild, moderate, and severe infected diabetic foot was 23.3%, 64.7% and 10.2%, respectively. The results of generalized linear models showed a correlation between Alb (OR = -1.74, 95%CI1.12-6.58, p = .023), CRP (OR = 2.13, 95%CI1.38-7.21, p = .014), PCT (OR = 2.01, 95%CI1.29-7.64, p = .013), microbial type (OR = 2.04, 95%CI1.43-7.83, p = .004) and ulcer infection severity. Conclusion: Alb, CRP, PCT and microbial type were among the factors influencing infection severity of diabetic foot ulcers.
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Affiliation(s)
- YiXin Luo
- School of Nursing, 26469Sun Yat-sen University, Guangzhou, China
| | - ShaoNa Niu
- Department of Endocrinology, 529858Linyi People's Hospital, Linyi, China
| | - LiFang Mai
- Department of Endocrinology, 56713Sun Yat-sen Memorial Hospital, 26469Sun Yat-sen University, Guangzhou, China
| | - XingZhou Liu
- Department of Endocrinology, 56713Sun Yat-sen Memorial Hospital, 26469Sun Yat-sen University, Guangzhou, China
| | - Chuan Yang
- Department of Endocrinology, 56713Sun Yat-sen Memorial Hospital, 26469Sun Yat-sen University, Guangzhou, China
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12
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Limb Salvage in Severe Diabetic Foot Infection. Foot Ankle Clin 2022; 27:655-670. [PMID: 36096557 DOI: 10.1016/j.fcl.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Severe diabetic foot infections (DFI) are both limb threatening and life threatening and associated with negative impact on health-related quality of life. Most severe DFIs require surgical intervention, and the goal of treatment should be preservation of limb function in addition to eradication of infection. Minor amputations are required in approximately 40% and major amputations in approximately 20% of patients. Significant risk factors for lower extremity amputation included male gender, smoking, previous amputation, osteomyelitis, peripheral artery disease, retinopathy, severe infections, gangrene, neuroischemic diabetic foot infections, leukocytosis, positive wound cultures, and isolation of gram-negative bacteria.
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Surme S, Saltoglu N, Kurt AF, Karaali R, Balkan II, Baghaki S, Caglar B, Ozdemir M, Vatan A, Togluk-Yigitoglu E, Budak B, Arapi B, Seker A, Can G, Gonen MS, Cetinkale O. Changing Bacterial Etiology and Antimicrobial Resistance Profiles as Prognostic Determinants of Diabetic Foot Infections: A Ten-Year Retrospective Cohort Study. Surg Infect (Larchmt) 2022; 23:667-674. [PMID: 36049074 DOI: 10.1089/sur.2022.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In this single-center study, we analyzed a retrospective cohort of patients with diabetic foot infections (DFIs) between 2011 and 2020. Patients and Methods: The first and second five-year periods were compared. A poor prognosis was defined as a primary composite end point including re-infection, major amputation, or mortality at six months. Results: A total of 484 patients were enrolled. Overall, 269 patients had the primary composite end point. A substantial decrease was detected in the second five-year period in terms of re-infection (n = 132, 66.0% vs. n = 68, 23.9%; p < 0.001) and mortality (n = 22, 11.0% vs. n = 7, 2.5%; p < 0.001). A total of 798 micro-organisms were isolated from 484 patients. A substantial increase was detected in polymicrobial infections (48.5% vs. 65.1%; p = 0.001) as well as Streptococcus spp. (2.5% vs. 9.2%; p = 0.003), Corynebacterium spp. (9.5% vs. 22.9%; p < 0.001), and extended-spectrum β-lactamase (ESBL) producing Escherichia coli (3.0% vs. 12.7%; p < 0.001) in the second five-year period, whereas the prevalence of multi-drug-resistanct (MDR) Pseudomonas aeruginosa (17.0% vs. 10.2%; p = 0.029) and carbapenem-resistant Acinetobacter baumannii (7.5% vs. 2.8%; p = 0.017) decreased. Multivariable regression analysis revealed that MDR Pseudomonas aeruginosa (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.074-3.420; p = 0.028) and carbapenem-resistant Acinetobacter baumannii (OR, 3.069; 95% CI, 1.114-8.453; p = 0.030) were independent predictors for poor prognosis. Conclusions: This 10-year cohort study provides reassuring information about the changing epidemiology of DFIs and the prognostic determinants in patients with DFIs.
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Affiliation(s)
- Serkan Surme
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Nese Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ahmet Furkan Kurt
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Semih Baghaki
- Department of Plastic and Reconstructive Surgery, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Bilge Caglar
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Meryem Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Aslı Vatan
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Eylem Togluk-Yigitoglu
- Department of General Surgery, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Beyhan Budak
- Department of Infectious Diseases and Clinical Microbiology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Berk Arapi
- Department of Cardiovascular Surgery, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ali Seker
- Department of Orthopaedics and Traumatology, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mustafa Sait Gonen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Oguz Cetinkale
- Department of Plastic and Reconstructive Surgery, Division of Endocrinology and Metabolism, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil. Antibiotics (Basel) 2022; 11:antibiotics11081125. [PMID: 36009994 PMCID: PMC9405336 DOI: 10.3390/antibiotics11081125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022] Open
Abstract
Diabetic foot infections (DFIs) are one of the causes of hospitalization in diabetic patients and, when this occurs, empirical antibiotic therapy is necessary. We have conducted a retrospective study of patients with DFI that required hospitalization to evaluate microbiologic profile and the susceptibility pattern of these infections. We evaluated 320 patients, of which 223 (69.7%) were male with a media age of 71 years with 276 isolates. Gram-positive bacteria were responsible for 188 (68.1%) of the isolates, while Gram-negative bacilli were responsible for 88 (31.9%). E. faecalis was the most prevalent pathogen, followed by S. aureus and coagulase negative Staphylococci. Among Gram-negative pathogens, P. aeruginosa was the most prevalent agent. Regarding the susceptibility profile, we found ampicillin-sensitive enterococci in 89% of the cases, oxacillin-sensitive S. aureus in 47%, but in coagulase-negative staphylococci, oxacillin was sensible only in 20%. The susceptibility profile of Gram-negatives was very good with 76% susceptibility of P. aeruginosa to ceftazidime and meropenem. The other prevalent Enterobacterales had great susceptibility to ceftazidime, piperacillin-tazobactam and 100% susceptibility to meropenem, with the exception of K. pneumoniae, which had 75% susceptibility to meropenem. Knowledge of microbiological profile and susceptibility patterns of patients with DFIs is useful to guide empirical therapy.
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Hsu CY, Lin SC, Wu YH, Hu CY, Chen YT, Chen YC. The Antimicrobial Effects of Bacterial Cellulose Produced by Komagataeibacter intermedius in Promoting Wound Healing in Diabetic Mice. Int J Mol Sci 2022; 23:ijms23105456. [PMID: 35628265 PMCID: PMC9142012 DOI: 10.3390/ijms23105456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Abstract
As a conventional medical dressing, medical gauze does not adequately protect complex and hard-to-heal diabetic wounds and is likely to permit bacterial entry and infections. Therefore, it is necessary to develop novel dressings to promote wound healing in diabetic patients. Komagataeibacter intermedius was used to produce unmodified bacterial cellulose, which is rarely applied directly to diabetic wounds. The produced cellulose was evaluated for wound recovery rate, level of inflammation, epidermal histopathology, and antimicrobial activities in treated wounds. Diabetic mices' wounds treated with bacterial cellulose healed 1.63 times faster than those treated with gauze; the values for the skin indicators in bacterial cellulose treated wounds were more significant than those treated with gauze. Bacterial cellulose was more effective than gauze in promoting tissue proliferation with more complete epidermal layers and the formation of compact collagen in the histological examination. Moreover, wounds treated with bacterial cellulose alone had less water and glucose content than those treated with gauze; this led to an increase of 6.82 times in antimicrobial protection, lower levels of TNF-α and IL-6 (39.6% and 83.2%), and higher levels of IL-10 (2.07 times) than in mice wounds treated with gauze. The results show that bacterial cellulose produced using K. intermedius beneficially affects diabetic wound healing and creates a hygienic microenvironment by preventing inflammation. We suggest that bacterial cellulose can replace medical gauze as a wound dressing for diabetic patients.
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Affiliation(s)
- Chou-Yi Hsu
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan;
| | - Sheng-Che Lin
- Department of Surgery, Tainan Municipal An-Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Yi-Hsuan Wu
- Department of Cardiovascular Surgery, Chi Mei Medical Center, Tainan 710402, Taiwan;
| | - Chun-Yi Hu
- Department of Food Science and Nutrition, Meiho University, Pingtung 912009, Taiwan;
| | - Yung-Tsung Chen
- Department of Food Science, National Taiwan Ocean University, Keelung City 202301, Taiwan;
| | - Yo-Chia Chen
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan;
- Department of Biological Science and Technology, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan
- Correspondence: ; Tel.: +88-68-7703-202 (ext. 5181); Fax: 88-68-7740-550
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Du F, Ma J, Gong H, Bista R, Zha P, Ren Y, Gao Y, Chen D, Ran X, Wang C. Microbial Infection and Antibiotic Susceptibility of Diabetic Foot Ulcer in China: Literature Review. Front Endocrinol (Lausanne) 2022; 13:881659. [PMID: 35663325 PMCID: PMC9161694 DOI: 10.3389/fendo.2022.881659] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the microbial spectrum isolated from foot ulcers among diabetic patients in China, which was conducted to help clinicians choose optimal antibiotics empirically. METHOD The PubMed, MEDLINE, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were searched for studies published between 2015 to 2019, that report primary data on diabetic foot infection (DFI) and antibiotic susceptibility in China. RESULT A total of 63 articles about DFI and antibiotic susceptibility tests among diabetic patients in China were included. There were 11,483 patients with an average age of 60.2 ± 10.1 years and a mean course of 10.6 ± 5.0 years between 2010 and 2019, covering most geographical regions of China. The prevalence of Gram-positive (GP) bacteria (43.4%) was lower than that of Gram-negative (GN) (52.4%). The most prevalent pathogens isolated were Staphylococcus aureus (17.7%), Escherichia coli (10.9%), Pseudomonas aeruginosa (10.5%), Klebsiella pneumoniae (6.2%), Staphylococcus epidermidis (5.3%), Enterococcus faecalis (4.9%), and fungus (3.7%). The prevalence of polymicrobial infection was 22.8%. GP bacteria were sensitive to linezolid, vancomycin, and teicoplanin. More than 50% of GN bacteria were resistant to third-generation cephalosporins, while the resistance rates of piperacillin/tazobactam, amikacin, meropenem, and imipenem were relatively low. Among the 6017 strains of the isolated organisms, 20% had multi-drug resistance (MDR). Staphylococcus aureus (30.4%) was the most predominant MDR bacteria, followed by extended-spectrum β-lactamase (ESBL) (19.1%). CONCLUSION The microbial infection of foot ulcers among diabetic patients in China is diverse. The microbial spectrum is different in different geographic regions and Staphylococcus aureus is the predominant bacteria. Polymicrobial and MDR bacterial infections on the foot ulcers are common. This study could be valuable in guiding the empirical use of antibiotics for diabetic foot infections.
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Da Silva J, Leal EC, Carvalho E. Bioactive Antimicrobial Peptides as Therapeutic Agents for Infected Diabetic Foot Ulcers. Biomolecules 2021; 11:biom11121894. [PMID: 34944538 PMCID: PMC8699205 DOI: 10.3390/biom11121894] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a devastating complication, affecting around 15% of diabetic patients and representing a leading cause of non-traumatic amputations. Notably, the risk of mixed bacterial–fungal infection is elevated and highly associated with wound necrosis and poor clinical outcomes. However, it is often underestimated in the literature. Therefore, polymicrobial infection control must be considered for effective management of DFU. It is noteworthy that antimicrobial resistance is constantly rising overtime, therefore increasing the need for new alternatives to antibiotics and antifungals. Antimicrobial peptides (AMPs) are endogenous peptides that are naturally abundant in several organisms, such as bacteria, amphibians and mammals, particularly in the skin. These molecules have shown broad-spectrum antimicrobial activity and some of them even have wound-healing activity, establishing themselves as ideal candidates for treating multi-kingdom infected wounds. Furthermore, the role of AMPs with antifungal activity in wound management is poorly described and deserves further investigation in association with antibacterial agents, such as antibiotics and AMPs with antibacterial activity, or alternatively the application of broad-spectrum antimicrobial agents that target both aerobic and anaerobic bacteria, as well as fungi. Accordingly, the aim of this review is to unravel the molecular mechanisms by which AMPs achieve their dual antimicrobial and wound-healing properties, and to discuss how these are currently being applied as promising therapies against polymicrobial-infected chronic wounds such as DFUs.
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Affiliation(s)
- Jessica Da Silva
- Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal;
- PhD Programme in Experimental Biology and Biomedicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
| | - Ermelindo C. Leal
- Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal;
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
- Correspondence: (E.C.L.); (E.C.)
| | - Eugénia Carvalho
- Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal;
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
- Correspondence: (E.C.L.); (E.C.)
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