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Yovera-Aldana M, Sifuentes-Hermenegildo P, Cervera-Ocaña MS, Mezones-Holguin E. Association of multidrug-resistant bacteria and clinical outcomes in patients with infected diabetic foot in a Peruvian hospital: A retrospective cohort analysis. PLoS One 2024; 19:e0299416. [PMID: 38833431 PMCID: PMC11149844 DOI: 10.1371/journal.pone.0299416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To evaluate the association of multidrug-resistant bacteria (MDRB) and adverse clinical outcomes in patients with diabetic foot infection (DFI) in a Peruvian hospital. MATERIALS AND METHODS This retrospective cohort study evaluated patients treated in the Diabetic Foot Unit of a General Hospital in Lima, Peru. MDRB was defined by resistance to more than two pharmacological groups across six clinically significant genera. The primary outcome was death due to DFI complications and/or major amputation. Other outcomes included minor amputation, hospitalization, and a hospital stay longer than 14 days. Relative risks were estimated using Poisson regression for all outcomes. RESULTS The study included 192 DFI patients with a mean age of 59.9 years; 74% were males. A total of 80.8% exhibited MDRB. The primary outcome had an incidence rate of 23.2% and 5.4% in patients with and without MDRB, respectively (p = 0.01). After adjusting for sex, age, bone involvement, severe infection, ischemia, diabetes duration, and glycosylated hemoglobin, MDRB showed no association with the primary outcome (RR 3.29; 95% CI, 0.77-13.9), but did with hospitalization longer than 14 days (RR 1.43; 95% CI, 1.04-1.98). CONCLUSIONS Our study found no association between MDRB and increased mortality and/or major amputation due to DFI complications, but did find a correlation with prolonged hospitalization. The high proportion of MDRB could limit the demonstration of the relationship. It is urgent to apply continuous evaluation of bacterial resistance, implement a rational plan for antibiotic use, and maintain biosafety to confront this threat.
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Affiliation(s)
- Marlon Yovera-Aldana
- Grupo de Investigación de Neurociencias, Efectividadad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Paola Sifuentes-Hermenegildo
- Departamento de Medicina, Servicio de Endocrinología, Hospital María Auxiliadora, Lima, Peru
- Red de Eficacia Clínica y Sanitaria, Lima, Perú
| | | | - Edward Mezones-Holguin
- Centro de Estudios Económicos y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Soluciones de Epi-gnosis, Piura, Peru
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Villa F, Marchandin H, Lavigne JP, Schuldiner S, Cellier N, Sotto A, Loubet P. Anaerobes in diabetic foot infections: pathophysiology, epidemiology, virulence, and management. Clin Microbiol Rev 2024:e0014323. [PMID: 38819166 DOI: 10.1128/cmr.00143-23] [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: 06/01/2024] Open
Abstract
SUMMARYDiabetic foot infections (DFI) are a public health problem worldwide. DFI are polymicrobial, biofilm-associated infections involving complex bacterial communities organized in functional equivalent pathogroups, all including anaerobes. Indeed, multiple pathophysiological factors favor the growth of anaerobes in this context. However, the prevalence, role, and contribution of anaerobes in wound evolution remain poorly characterized due to their challenging detection. Studies based on culture reviewed herein showed a weighted average of 17% of patients with anaerobes. Comparatively, the weighted average of patients with anaerobes identified by 16S rRNA gene sequencing was 83.8%. Culture largely underestimated not only the presence but also the diversity of anaerobes compared with cultivation-independent approaches but both methods showed that anaerobic Gram-negative bacilli and Gram-positive cocci were the most commonly identified in DFI. Anaerobes were more present in deeper lesions, and their detection was associated with fever, malodorous lesions, and ulcer depth and duration. More specifically, initial abundance of Peptoniphilus spp. was associated with ulcer-impaired healing, Fusobacterium spp. detection was significantly correlated with the duration of DFI, and the presence of Bacteroides spp. was significantly associated with amputation. Antimicrobial resistance of anaerobes in DFI remains slightly studied and warrants more consideration in the context of increasing resistance of the most frequently identified anaerobes in DFI. The high rate of patients with DFI-involving anaerobes, the increased knowledge on the species identified, their virulence factors, and their potential role in wound evolution support recommendations combining debridement and antibiotic therapy effective on anaerobes in moderate and severe DFI.
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Affiliation(s)
- Fanny Villa
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
| | - Hélène Marchandin
- HydroSciences Montpellier, Univ Montpellier, CNRS, IRD, Service de Microbiologie et Hygiène, Hospitalière, CHU Nîmes, Nîmes, France
| | - Jean-Philippe Lavigne
- VBIC, INSERM U1047, Univ Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
| | - Sophie Schuldiner
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Métaboliques et Endocriniennes, CHU Nîmes, Nîmes, France
| | | | - Albert Sotto
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
| | - Paul Loubet
- VBIC, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
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Rajab AAH, Hegazy WAH. What’s old is new again: Insights into diabetic foot microbiome. World J Diabetes 2023; 14:680-704. [PMID: 37383589 PMCID: PMC10294069 DOI: 10.4239/wjd.v14.i6.680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/20/2023] [Accepted: 04/10/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians. The prevalence of diabetes in the global population continues to grow to alarming levels year after year, causing an increase in the incidence of diabetes complications and health care costs all over the world. One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients, which is considered a definitive factor in all cases. Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection, limb amputations, and life-threatening systemic infections. In this review, we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior. In addition, we shed light on the different treatment strategies that aim at eradicating the infection.
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Affiliation(s)
- Azza A H Rajab
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagzig 44511, Egypt
| | - Wael A H Hegazy
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagzig 44511, Egypt
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Körpinar Ş. A Retrospective Analysis of Microbiologic Profile of Foot Infections in Patients With Diabetic End-Stage Renal Disease. INT J LOW EXTR WOUND 2020; 20:15-21. [DOI: 10.1177/1534734620958364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Individuals with diabetes and end-stage renal disease (ESRD) are at increased risk of foot ulceration and lower extremity amputation. Although risk factors and microbiologic analysis of diabetic foot infections ( DFIs) have been extensively studied, there are limited data available for this characteristic group. Methods Clinical, demographic, laboratory, microbiological data, and foot examination information were collected retrospectively regarding 94 patients with ESRD who were referred for DFI between 2006 and 2016 to hyperbaric oxygen therapy. Results In 6 of 94 patients with ESRD (mean age 60 years; 65 males [69.1%], 29 women [30.8%]; 91 undergoing hemodialysis [96.8%], one peritoneal dialysis [1%], two [2%] recent renal transplants), the lesions were bilateral; therefore, the evaluations were made over 100 DFIs. The most common pathogens isolated in deep wound cultures were Staphylococcus aureus and Pseudomonas aeruginosa, respectively, contributing to 27 (21.2%) and 16 (12.5%) of all 127 isolates. When the distribution of the isolates according to different Wagner grades were analyzed, it was found that the proportion of Gramnegative isolates increased statistically significantly with the ascending Wagner grade (P = .004). Conclusion DFIs indicate a serious complication associated with a high risk of amputation, prolonged antibiotic treatment, increased hospital and procedure demands, and the cost of health care, on patients with ESRD. The familiarization of causative pathogens underlying DFIs can aid the clinicians in the choice of appropriate empirical antibiotic treatment. This study emphasizes the need for greater attention to risk factors and the microbiologic profile of DFIs in this characteristic group.
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Cawich SO, Naraynsingh V, Jonallagadda R, Wilkinson C. Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections. World J Surg Proced 2019; 9:12-18. [DOI: 10.5412/wjsp.v9.i2.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/15/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Ramesh Jonallagadda
- Department of Surgery, University of the West Indies, Cave Hill, Barbados, West Indies
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Cawich SO, Naraynsingh V, Jonallagadda R, Wilkinson C. Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections. World J Surg Proced 2019. [DOI: 10.5412/wjsp.v9.i2.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Dunyach-Remy C, Ngba Essebe C, Sotto A, Lavigne JP. Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis. Toxins (Basel) 2016; 8:toxins8070209. [PMID: 27399775 PMCID: PMC4963842 DOI: 10.3390/toxins8070209] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 12/17/2022] Open
Abstract
Infection of foot ulcers is a common, often severe and costly complication in diabetes. Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated. The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI. The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection. Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes) and non-toxinogenic strains. Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis. Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds.
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Affiliation(s)
- Catherine Dunyach-Remy
- Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France.
- Service de Microbiologie, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France.
| | - Christelle Ngba Essebe
- Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France.
| | - Albert Sotto
- Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France.
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France.
| | - Jean-Philippe Lavigne
- Institut National de la Santé Et de la Recherche Médicale U1047, Université de Montpellier, UFR de Médecine, Nîmes 30908, France.
- Service de Microbiologie, Centre Hospitalo-Universitaire Carémeau, Nîmes 30029, France.
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Lipsky BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S, Lavery L, Senneville É, Urbančič-Rovan V, Van Asten S, Peters EJG. IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:45-74. [PMID: 26386266 DOI: 10.1002/dmrr.2699] [Citation(s) in RCA: 332] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Benjamin A Lipsky
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- University of Oxford, Oxford, UK
| | | | - Mathew Diggle
- Nottingham University Hospitals Trust, Nottingham, UK
| | - John Embil
- University of Manitoba, Winnipeg, MB, Canada
| | - Shigeo Kono
- WHO-collaborating Centre for Diabetes, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Lawrence Lavery
- University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX, USA
| | | | | | - Suzanne Van Asten
- University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX, USA
- VU University Medical Centre, Amsterdam, The Netherlands
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9
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Yusuf N, Zakaria A, Omar MI, Shakaff AYM, Masnan MJ, Kamarudin LM, Abdul Rahim N, Zakaria NZI, Abdullah AA, Othman A, Yasin MS. In-vitro diagnosis of single and poly microbial species targeted for diabetic foot infection using e-nose technology. BMC Bioinformatics 2015; 16:158. [PMID: 25971258 PMCID: PMC4430918 DOI: 10.1186/s12859-015-0601-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 04/28/2015] [Indexed: 12/16/2022] Open
Abstract
Background Effective management of patients with diabetic foot infection is a crucial concern. A delay in prescribing appropriate antimicrobial agent can lead to amputation or life threatening complications. Thus, this electronic nose (e-nose) technique will provide a diagnostic tool that will allow for rapid and accurate identification of a pathogen. Results This study investigates the performance of e-nose technique performing direct measurement of static headspace with algorithm and data interpretations which was validated by Headspace SPME-GC-MS, to determine the causative bacteria responsible for diabetic foot infection. The study was proposed to complement the wound swabbing method for bacterial culture and to serve as a rapid screening tool for bacteria species identification. The investigation focused on both single and poly microbial subjected to different agar media cultures. A multi-class technique was applied including statistical approaches such as Support Vector Machine (SVM), K Nearest Neighbor (KNN), Linear Discriminant Analysis (LDA) as well as neural networks called Probability Neural Network (PNN). Most of classifiers successfully identified poly and single microbial species with up to 90% accuracy. Conclusions The results obtained from this study showed that the e-nose was able to identify and differentiate between poly and single microbial species comparable to the conventional clinical technique. It also indicates that even though poly and single bacterial species in different agar solution emit different headspace volatiles, they can still be discriminated and identified using multivariate techniques.
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Affiliation(s)
- Nurlisa Yusuf
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | - Ammar Zakaria
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | - Mohammad Iqbal Omar
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | - Ali Yeon Md Shakaff
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | - Maz Jamilah Masnan
- Institute for Engineering Mathematics, Universiti Malaysia Perlis, Perlis, Malaysia.
| | | | - Norasmadi Abdul Rahim
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | - Nur Zawatil Isqi Zakaria
- Centre of Excellence for Advanced Sensor Technology, Universiti Malaysia Perlis, Perlis, Malaysia.
| | | | - Amizah Othman
- Department of Microbiology
- , Hospital Tuanku Fauziah, Jalan Kolam, Kangar, Perlis, Malaysia.
| | - Mohd Sadek Yasin
- Department of Microbiology
- , Hospital Tuanku Fauziah, Jalan Kolam, Kangar, Perlis, Malaysia.
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Charles PGP, Uçkay I, Kressmann B, Emonet S, Lipsky BA. The role of anaerobes in diabetic foot infections. Anaerobe 2015; 34:8-13. [PMID: 25841893 DOI: 10.1016/j.anaerobe.2015.03.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 12/25/2022]
Abstract
Diabetic foot infections (DFI) are a common cause of morbidity and, on occasion, even mortality. Infection can be either mono- or polymicrobial, with a wide variety of potential pathogens. Anaerobes may be involved, particularly in wounds that are deeper or more chronic, and are more frequently identified when using modern molecular techniques, such as 16s PCR and pyrosequencing. It remains unclear whether the presence of anaerobes in DFI leads to more severe manifestations, or if these organisms are largely colonizers associated with the presence of greater degrees of tissue ischemia and necrosis. Commonly used empiric antibiotic therapy for diabetic foot infections is generally broad-spectrum and usually has activity against the most frequently identified anaerobes, such as Peptostreptococcus and Bacteroides species. Adequate surgical debridement and, when needed, foot revascularization may be at least as important as the choice of antibiotic to achieve a successful treatment outcome.
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Affiliation(s)
- Patrick G P Charles
- Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Parkville, Australia.
| | - Ilker Uçkay
- Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Kressmann
- Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stéphane Emonet
- Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Laboratory of Bacteriology, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin A Lipsky
- Infectious Diseases Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Medical Sciences (Infectious Diseases), University of Oxford, Oxford, UK
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Cawich SO, Harnarayan P, Islam S, Budhooram S, Ramsewak S, Naraynsingh V. Adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies. Risk Manag Healthc Policy 2014; 7:239-43. [PMID: 25473322 PMCID: PMC4251569 DOI: 10.2147/rmhp.s72236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of conventional medical therapy in diabetic foot infections is to control infection, thereby reducing amputation rates, infectious morbidity, and death. Any delay incurred during a trial of home remedies could allow an infection to progress unchecked, increasing the risk of these adverse outcomes. This study sought to determine the effects of delayed operative interventions and amputations in these patients. Methods A questionnaire study targeting all consecutive patients admitted with diabetic foot infection was carried out over 1 year. Two groups were defined, ie, a medical therapy group comprising patients who sought medical attention after detecting their infection and a home remedy group comprising those who voluntarily chose to delay medical therapy in favor of home remedies. The patients were followed throughout their hospital admissions. We recorded the duration of hospitalization and number of operative debridements and amputations performed. Results There were 695 patients with diabetic foot infections, comprising 382 in the medical therapy group and 313 in the home remedy group. Many were previously hospitalized for foot infections in the medical therapy (78%) and home remedy (74.8%) groups. The trial of home remedies lasted for a mean duration of 8.9 days. The home remedy group had a longer duration of hospitalization (16.3 versus 8.5 days; P<0.001), more operative debridements (99.7% versus 94.5%; P<0.001), and more debridements per patient (2.85 versus 2.45; P<0.001). Additionally, in the home remedy group, there was an estimated increase in expenditure of US $10,821.72 US per patient and a trend toward more major amputations (9.3% versus 5.2%; P=0.073). Conclusion There are negative outcomes when patients delay conventional medical therapy in favour of home remedies to treat diabetic foot infections. These treatments need not be mutually exclusive. We encourage persons with diabetes who wish to try home remedies to seek medical advice in addition as a part of holistic care.
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Affiliation(s)
- Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
| | - Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
| | - Shariful Islam
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
| | - Steve Budhooram
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
| | - Shivaa Ramsewak
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies
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Zenelaj B, Bouvet C, Lipsky BA, Uçkay I. Do Diabetic Foot Infections With Methicillin-Resistant Staphylococcus aureus Differ From Those With Other Pathogens? INT J LOW EXTR WOUND 2014; 13:263-72. [DOI: 10.1177/1534734614550311] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is controversy as to whether or not diabetic foot infections (DFIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with worse outcomes than DFIs caused by other pathogens. To address this issue we performed a nonsystematic literature search of published articles in English language journals seeking studies reporting on the outcomes of DFIs related to their microbiology. We retrieved 48 articles published from 1999 to 2013 that described a total of 7771 cases of DFI. The overall proportion of DFIs with an isolate of S aureus was about 30%; just over one third of these (11% of all cases) were MRSA strains. Among the DFI cases caused by MRSA 1543 were episodes of soft tissue infections and 113 of osteomyelitis, while non-MRSA organisms caused 5761 soft tissue infections and 354 cases of osteomyelitis. Only 5 of the included articles attempted a comparison between DFI caused by MRSA and those caused by other pathogens, with no clear differences noted. The median total duration of antibiotic therapy for DFI caused by MRSA was 26 days, of which a median of 10 days was given intravenously. Only a few articles reported the proportion of patients with a recurrence, but they often did not differentiate between MRSA and non-MRSA cases. Four publications reported a worse functional or microbiological outcome in MRSA, compared to non-MRSA, cases, but the findings were variable and differences did not seem to be significant. Many trials failed to adjust for case-mix or to definitively demonstrate a relationship between microbiology and outcomes. Few of the articles specifically commented on whether the MRSA isolates were health care- or community-acquired strains. Notwithstanding the substantial limitations of the available literature, there does not appear to be a need for any special treatment for DFI caused by MRSA. The current guidelines for treating according to established international recommendations seem appropriate.
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Affiliation(s)
- Besa Zenelaj
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Cindy Bouvet
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin A. Lipsky
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- University of Oxford, Oxford, UK
| | - Ilker Uçkay
- Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Cawich SO, Harnarayan P, Budhooram S, Bobb NJ, Islam S, Naraynsingh V. Wonder of Life (kalanchoe pinnata) leaves to treat diabetic foot infections in Trinidad & Tobago: a case control study. Trop Doct 2014; 44:209-13. [PMID: 25082340 DOI: 10.1177/0049475514543656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED : Wonder of Life (kalanchoe pinnata) leaves are commonly used to treat diabetic foot infections. These patients are usually non-compliant with conventional medical therapy. We surmised that these patients would have a higher incidence of treatment failures. Patients admitted with diabetic foot infections were separated into two groups: a Study Group comprised patients who used topical kalanchoe pinnata and a Medical Therapy Group contained patients who were compliant with conventional treatment. The patients were observed over the course of their hospitalisation. RESULTS There were 382 patients in the Medical Therapy Group and 96 in the Study Group, who waited 9.21 ± 5.3 days (Mean ± SD) before seeking medical attention. There were similar rates of all amputations (34.8% vs. 37.5%; P = 0.643) and mortality (0.8% vs. 1.0%; P = 1.000) in the Study and Medical Therapy groups. CONCLUSIONS There may be value in the use of topical kalanchoe pinnata to treat diabetic foot infections.
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Affiliation(s)
- Shamir O Cawich
- Senior Lecturer in Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Patrick Harnarayan
- Lecturer in Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Steve Budhooram
- Associate Lecturer in Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Nahmorah J Bobb
- Resident in Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Shariful Islam
- Resident in Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Vijay Naraynsingh
- Professor of Surgery, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
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Dan D, Rambally R, Cawich SO, Maharaj R, Naraynsingh V. Solid pseudopapillary neoplasms of the pancreas: a report of two cases. Case Rep Med 2014; 2014:356379. [PMID: 24982677 PMCID: PMC4058598 DOI: 10.1155/2014/356379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 02/07/2023] Open
Abstract
Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging. We report two cases of patients with solid pseudopapillary pancreatic tumors and review the existing literature.
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Affiliation(s)
- Dilip Dan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Rakesh Rambally
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Shamir O. Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
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Harnarayan P, Cawich SO, Islam S, Ramsewak S, Naraynsingh V. Self-directed treatment for lower limb wounds in persons with diabetes: a short report. Patient Prefer Adherence 2014; 8:1173-7. [PMID: 25214770 PMCID: PMC4159497 DOI: 10.2147/ppa.s68680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIM There has been little focus on self-directed treatment for lower limb wounds, although it a common practice among persons with diabetes across the Caribbean. We sought to document this practice in a Caribbean nation. METHODS We prospectively interviewed all consecutive patients with diabetes who were admitted with lower limb wounds at the San Fernando General Hospital in Trinidad and Tobago over a period of 18 months. A questionnaire was used to collect data on patient demographics, use of self-directed treatment, and details of these treatments. RESULTS Of 839 persons with diabetes who were admitted with infected lower limb wounds, 344 (41%) admitted to self-directed treatment before seeking medical attention. These patients were predominantly male (59.9%) at a mean age of 56.4±12.4 years. The practice was most common in persons of Afro-Caribbean descent (45.9%) and those with type 2 diabetes (93.9%). In this group, 255 (74.4%) patients were previously admitted to hospital for lower limb infections. And of those, 32 (12.6%) had a prior amputation and 108 (42.4%) had at least one operative debridement specifically for foot infections. CONCLUSION Caribbean cultural practices may be an important contributor to negative outcomes when treating lower limb wounds in persons with diabetes. Despite being acutely aware of the potentially devastating consequences of inadequate treatment, 41% of our patients with diabetes still opted to use self-directed treatment for lower limb wounds. This deserves further study in order to give a more tailored approach in care delivery.
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Affiliation(s)
- Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago
- Correspondence: Shamir O Cawich, Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, Tel +1 868 798 9627, Email
| | - Shariful Islam
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Shivaa Ramsewak
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago
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