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dos Santos VP, de Andrade Barberino MGM, Alves CAS. Microbiological Species and Antibiotic Resistance in Diabetic and Nondiabetic Lower Extremity Wounds: A Comparative Cross-Sectional Study. INT J LOW EXTR WOUND 2024; 23:338-346. [PMID: 34747258 PMCID: PMC11059827 DOI: 10.1177/15347346211053936] [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: 11/17/2022]
Abstract
Severe lower extremity wounds have an increased risk of complications and limb loss. The aim of this study was to evaluate and compare the microbiological profile and antibiotic resistance of wounds in diabetic and nondiabetic patients. A cross-sectional comparative study was carried out at a public hospital including 111 patients with moderate to severe wound infections. Tissue samples were collected during a surgical procedure. One hundred and four patients (94%) had positive cultures and 88 (79%) had a Gram-negative microorganism. Among the 185 cultured microorganisms, 133 (72%) were Gram-negative species. Pseudomonas aeruginosa (23 cases) was the most isolated Gram-negative species, and Enterococcus faecalis (26 cases) was the most prevalent Gram-positive species. Among 185 isolated species, 45 (24%) were extended-spectrum beta-lactamase producers, 23 (12%) were carbapenem-resistant, and 5 (3%) were methicillin-resistant Staphylococcus aureus. Findings revealed that there was no significant difference in the microbiological profile and antibiotic resistance among patients with lower extremity wounds whether they were diabetic or nondiabetic.
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Nascimento LD, Lopes ACP, Teixeira MM, da Silva JMA, Silva LO, de Almeida JB, Campos GB, Teodósio R, Marques LM. Clinical and Microbiological Profile of Diabetic Foot Ulcers Infected With Staphylococcus aureus in a Regional General Hospital in Bahia, Brazil. INT J LOW EXTR WOUND 2024; 23:252-263. [PMID: 34747264 DOI: 10.1177/15347346211050771] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is necessary to know the resistance profile of Staphylococcus aureus to better control diabetic foot ulcer infections, to establish rational antibiotic therapy, and to avoid the development of resistant strains. This cross-sectional study evaluated the clinical parameters, virulence, and antimicrobial resistance profiles of S aureus in patients with diabetic foot disease admitted to a public hospital. S aureus strains were identified in patients with diabetes with amputation indication. Infected tissue samples were collected, microbes were isolated and identified. The microbial resistance profile was determined. Samples were also analyzed for biofilm formation and other virulence markers. The 34 individuals examined were mostly men, black, aged 60 years on average, and generally had a low income and education level. Most individuals had type 2 diabetes, and the mean time since diagnosis was 13.9 years. On an SF-36 (the Medical Outcomes Study 36-item short-form health survey) quality-of-life questionnaire, 75% of individuals obtained a score equal to 0 for physical impairment. S aureus specimens from 17 patients were isolated, corresponding to 50% of samples. Five isolates were classified as methicillin-resistant S aureus (MRSA). Molecular typing revealed that 20% of MRSA strains were SCCmec type V and 80% were type I. All isolates were sensitive to doxycycline; 61.5% were resistant to erythromycin, 38.5% to cefoxitin, 30.7% to clindamycin and ciprofloxacin, 23% to meropenem, 15.3% to gentamicin, 38.5% to oxacillin, and 7.7% (one strain) to vancomycin. Regarding biofilm production, 53% of samples were able to produce biofilms, and 84.6% had icaA and/or icaD genes. Additionally, the following enterotoxin genes were identified in the isolates: seb, sec, seg, and sei (5.9%, 5.9%, 11.8%, and 23.9%, respectively) and agr types 1 (5.9%) and 2 (11.8%). Genotypic evaluation made it possible to understand the pathogenicity of S aureus strains isolated from the diabetic foot; laboratory tests can assist in the monitoring of patients with systemic involvement.
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Affiliation(s)
| | | | - Mariana Morais Teixeira
- Federal University of Bahia, Multidisciplinary Institute in Health, Vitória da Conquista, Bahia, Brazil
| | | | - Letícia Oliveira Silva
- Federal University of Bahia, Multidisciplinary Institute in Health, Vitória da Conquista, Bahia, Brazil
| | - Jessica Bomfim de Almeida
- Federal University of Bahia, Multidisciplinary Institute in Health, Vitória da Conquista, Bahia, Brazil
| | - Guilherme Barreto Campos
- Federal University of Bahia, Multidisciplinary Institute in Health, Vitória da Conquista, Bahia, Brazil
| | - Rosa Teodósio
- Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL; Global Health and Tropical Medicine,, Lisbon, Portugal
| | - Lucas Miranda Marques
- Federal University of Bahia, Multidisciplinary Institute in Health, Vitória da Conquista, Bahia, Brazil
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Aftab IB, Ahmed A, Alvi SA, Akhtar F. Bacterial Diversity with Emerging Antimicrobial Resistance of Diabetic Foot Ulceration and Current Detection Techniques: A Review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Molines-Barroso RJ, García-Morales E, Sevillano-Fernández D, García-Álvarez Y, Álvaro-Afonso FJ, Lázaro-Martínez JL. Culture Concordance in Different Sections of the Metatarsal Head: Interpretations of Microbiological Results. INT J LOW EXTR WOUND 2021; 22:270-277. [PMID: 33909483 DOI: 10.1177/15347346211003722] [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: 11/16/2022]
Abstract
Microbiological cultures of per-wound bone biopsies have shown a lack of correlation and a high rate of false-negative results when compared with bone biopsy cultures in diabetic foot osteomyelitis. The selection of samples from the area of active osteomyelitis, which contains a complete census of the microorganisms responsible for the infection, is essential to properly guide antimicrobial treatment. We aimed to comparatively evaluate the quantitative and qualitative cultures taken from different areas, in metatarsal heads resected for osteomyelitis. For this purpose, we consecutively selected 13 metatarsal heads from 12 outpatients with plantar ulcers admitted to our diabetic foot unit. Metatarsal heads were divided transversally into 3 portions: plantar (A), central (B), and dorsal (C), and the 39 resulting samples were cultured. Qualitative and quantitative microbiological analysis was performed, and the isolated species and bacterial load, total and species specific, were compared between the 3 metatarsal bone segments. The primary outcome of the study was the bacterial diversity detected in the different bone sections. Cultures were positive in 12 of the 13 included metatarsal heads (92%). A total of 34 organisms were isolated from all specimens. Ten of the 12 cultures (83%) were polymicrobial. Ten of the 13 metatarsal heads (77%) had identical microbiological results in each of the 3 bone sections. The largest number of microorganisms was found in the central section. The overall concordance between sections was 91%. The predominant microorganisms were coagulase-negative staphylococci (41%). Statistical differences were not found in the bioburden between sections (range 3.25-3.41 log10 colony-forming unit/g for all sections; P = .511). The results of our study suggest that microorganisms exhibit a high tendency to spread along the metatarsal bone and that the degree of progression along the bone is species dependent. The central portions of metatarsal bones tend to accumulate a higher diversity of species. Thus, we recommend this area of bone for targeted biopsy in patients with suspected osteomyelitis.
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Affiliation(s)
- Raul Juan Molines-Barroso
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Esther García-Morales
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Sevillano-Fernández
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Yolanda García-Álvarez
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J Álvaro-Afonso
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Andrianaki AM, Koutserimpas C, Kafetzakis A, Tavlas E, Maraki S, Papadakis JA, Ioannou P, Samonis G, Kofteridis DP. Diabetic foot infection and osteomyelitis. Are deep-tissue cultures necessary? Germs 2020; 10:346-355. [PMID: 33489950 DOI: 10.18683/germs.2020.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
Introduction Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods This is a prospective study conducted during a 4-year period. All patients with DFIs and/or diabetic foot osteomyelitis (DFO) admitted to the University Hospital of Heraklion, Greece, were included. Clinical data were collected, while cultures taken with swabs and/or tissue biopsies were used as indicators of the microbiological cause and the appropriate treatment. Results In total, 83 individuals (62.7% males) with mean age of 72 years, were enrolled. Coexisting osteomyelitis was present in 18.1%. From tissue and pus cultures, 131 and 176 pathogens, respectively, were isolated. Gram-positive aerobes were the most common microorganisms, followed by Gram-negatives. Infection was polymicrobial in 40 (70.2%) out of 57 patients with tissue culture and in 54 (75.0%) out of 72 with pus culture. Microbiological results from tissue cultures were compatible with those from pus at a rate of 80%, while in cases of osteomyelitis concordance reached 100%. Multidrug-resistant organisms (MDROs) were isolated from 32 (24.4%) tissue and 44 (25%) pus cultures (p=0.910). Initial empirical antimicrobial treatment was considered inappropriate in 44.6% of cases. Conclusions A high concordance between easily taken swab cultures and those taken by biopsy was noted, especially in DFO. This was helpful for early change to appropriate treatment in cases where MDROs were isolated and empirical treatment was inappropriate. Further research is needed to confirm this observation in clinical practice.
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Affiliation(s)
- Angeliki M Andrianaki
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Christos Koutserimpas
- MD, Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, PC 11525, Greece
| | - Alexandros Kafetzakis
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Emmanouil Tavlas
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Sofia Maraki
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - John A Papadakis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - George Samonis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Diamantis P Kofteridis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
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Papanas N, Papi M, Rerkasem K. A New Issue: Sweet Grapes of Autumn. INT J LOW EXTR WOUND 2020; 18:217-218. [PMID: 31514631 DOI: 10.1177/1534734619876251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Massimo Papi
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Kittipan Rerkasem
- NCD Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Frequency and Antimicrobial Susceptibility Patterns of Diabetic Foot Infection of Patients from Bandar Abbas District, Southern Iran. J Pathog 2020; 2020:1057167. [PMID: 32566310 PMCID: PMC7301187 DOI: 10.1155/2020/1057167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot infection is among the most common complications of diabetes mellitus which significantly causes hospitalization and is the most prevalent etiology of nontraumatic amputation worldwide. The current study aimed at assessing the frequency and antimicrobial susceptibility patterns of diabetic foot infection of patients from the Bandar Abbas area, in the south of Iran. In this study, a total of 83 diabetic patients with diabetic infected foot wounds referring to Shahid Mohammadi Hospital, Bandar Abbas, from 2017 to 2018 were assessed. Samples were obtained from wound sites and evaluated by aerobic culture and also an antibiogram test for antibiotic susceptibility. Factors including age, sex, type of diabetes, the medication used for diabetes, previous history of diabetic foot infection, duration of wound incidence, fever, and laboratory indices were recorded for each subject. The most prevalent detected bacteria were Escherichia coli (20.5%), Enterococcus sp. (16.9%), Klebsiella sp. (12%), Staphylococcus aureus (8.4%), Enterobacter sp. (7.2%), and Acinetobacter sp. (6%). The results of antibiogram tests revealed the most and the least antibiotic sensitivity for E. coli sp. as meropenem and ciprofloxacin, for Enterococcus sp. as gentamicin and ciprofloxacin, for Klebsiella sp. as amikacin and cotrimoxazole, and for Enterobacter sp. as cotrimoxazole and both amikacin and ciprofloxacin. Staphylococcus aureus was sensitive to vancomycin and doxycycline, and Acinetobacter sp. was 100% resistant to all antibiotics except amikacin and gentamycin. A significant statistical association was found between the C-reactive protein and the patients' diabetic foot infection organisms (P=0.019). Findings of the study revealed E. coli sp. as the most common bacteria which are infecting the foot lesions in the studied population. The highest antibiotic susceptibility was seen for vancomycin, linezolid, and carbapenem.
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Machado C, Teixeira S, Fonseca L, Abreu M, Carvalho A, Pereira MT, Amaral C, Freitas C, Ferreira L, Neto HR, Loureiro L, Martins J, Costa L, Gomes A, Pereira J, Guimarães R, Pinto S, Carvalho R. Evolutionary trends in bacteria isolated from moderate and severe diabetic foot infections in a Portuguese tertiary center. Diabetes Metab Syndr 2020; 14:205-209. [PMID: 32171163 DOI: 10.1016/j.dsx.2020.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetic Foot infections (DFI) are a major cause of hospitalization in patients with diabetes. The microbiological study of diabetic ulcers is essential to adequate antibiotic therapy and to minimize the selection of resistant microorganisms. The aim of this study was to characterize and to compare the evolution of isolated microorganisms between the biennium 2010-2011 and 2016-2017, in hospitalized patients with DFI. MATERIAL AND METHODS Retrospective evaluation of the clinical and analytical data of patients who were admitted due to DFI in 2010-2011 (group 2010/11) and 2016-2017 (group 2016/17). Only the first hospitalization for each patient was included. An adequate descriptive and comparative statistical analysis was performed. RESULTS There were 274 admissions due to DFI, 151 in 2010/11 and 123 in 2016/17. There was an increase in admissions due to neuroischemic DFI (51.0% in 2010/11 to 61.8% in 2016/17, p = 0.048). Staphylococcus aureus (SA) was the most common isolate in 2010/11 (26.7%). In 2016/17 most cultures were mixed polymicrobial and isolation of Enterobacteriaceae and Pseudomonas aeruginosa increased from 2010/11 to 2016/17 (15.9% to 30.6%, p = 0.001, and 9.1% to 13.7%, p = 0.048, respectively). CONCLUSION There was an increase in the prevalence of neuroischemic DFU. The Enterobacteriaceae family replaced SA as the most prevalent pathogen in DFI, with an increase in the isolation of gram-negative microorganisms and mixed polymicrobial cultures. Chronic neuroischemic infected ulcers usually present distinct bacterial isolates; knowledge about the most common agents is warranted in order to better select empiric antibiotic therapy.
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Affiliation(s)
- Catarina Machado
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.
| | - Sofia Teixeira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Liliana Fonseca
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Miguel Abreu
- Department of Infectious Diseases, Centro Hospitalar Do Porto, Portugal
| | - André Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Maria Teresa Pereira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Cláudia Amaral
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Cláudia Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Lia Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Helena Rei Neto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Luís Loureiro
- Department of Angiology and Vascular Surgery, Centro Hospitalar do Porto, Portugal
| | - Joana Martins
- Department of Angiology and Vascular Surgery, Centro Hospitalar do Porto, Portugal
| | - Luís Costa
- Department of Orthopaedics and Traumatology, Centro Hospitalar Do Porto, Portugal
| | - André Gomes
- Department of Orthopaedics and Traumatology, Centro Hospitalar Do Porto, Portugal
| | - Joel Pereira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Rosa Guimarães
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Sara Pinto
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
| | - Rui Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Do Porto, Portugal
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Papanas N, Papi M, Rerkasem K. The Science of Wound Healing: Perhaps, “More Lovely and More Temperate”? INT J LOW EXTR WOUND 2019; 18:110-111. [DOI: 10.1177/1534734619863116] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre–Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Massimo Papi
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Kittipan Rerkasem
- NCD Centre of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Viswanathan V, Pendsey S, Radhakrishnan C, Rege TD, Ahdal J, Jain R. Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infection in India: A Growing Menace. INT J LOW EXTR WOUND 2019; 18:236-246. [DOI: 10.1177/1534734619853668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetic foot infection (DFI) is a serious and common complication of diabetes mellitus. These infections are potentially disastrous and rapidly progress to deeper spaces and tissues. If not treated promptly and appropriately, DFI can be incurable or even lead to septic gangrene, which may require foot amputation. Mostly, these infections are polymicrobial, where Gram-positive pathogens mainly Staphylococcus aureus play a dominant causative role. Methicillin-resistant Staphylococcus aureus (MRSA) is present in 10% to 32% of diabetic infections and is associated with a higher rate of treatment failure, morbidity, and hospitalization cost in patients with DFIs. The increasing resistance of bacteria and the adverse effects pertaining to the safety and tolerability towards currently available anti-MRSA agents have limited the available treatment options for patients with DFI. Infection control, antimicrobial stewardship, and rapid diagnostics based on the microbiological culture and the antimicrobial susceptibility testing results are important components in helping curb this disturbing trend. Emphasis to revisit a vigorous research effort in order to improve the therapeutic options for the increasingly resistant and highly adaptable MRSA is the need of hour. Through this review article, we have made an attempt to explore the ongoing therapeutic trends in the management of DFI and highlighted the challenges in treatment of DFI. We have also given a brief overview of a few novel drugs that are under development to treat MRSA infections.
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Affiliation(s)
| | | | | | | | | | - Rishi Jain
- Wockhardt Ltd, Bandra Kurla Complex, Mumbai, India
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Papanas N, Papi M, Rerkasem K. Progress in Wound Healing: Wisdom Not Consumed in Confidence? INT J LOW EXTR WOUND 2019; 18:5. [DOI: 10.1177/1534734619837551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Massimo Papi
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Kittipan Rerkasem
- NCD Center of Excellence, Research Institute of Health Sciences at Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Neves JM, Duarte B, Pinto M, Formiga A, Neves J. Diabetic Foot Infection: Causative Pathogens and Empiric Antibiotherapy Considerations—The Experience of a Tertiary Center. INT J LOW EXTR WOUND 2019; 18:122-128. [DOI: 10.1177/1534734619839815] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Most moderate-to-severe diabetic foot infections (DFIs) require hospitalization with urgent surgical approach and administration of empiric antibiotherapy. To ensure optimal antibiotic coverage, regular microbiological background updates are imperative. The purpose is to characterize the microbiological profile and the antibiotic sensitivity pattern of the DFI causative pathogens isolated within a specialized DFI unit of a tertiary hospital, in order to establish evidence-based policies regarding empirical antibiotic use. A cross-sectional study was conducted. Microbiological cultures and corresponding antibiotic sensitivity tests collected from moderate-to-severe DFIs as a first approach to the hospitalized patient were retrieved and analyzed during a 12-month period. Two groups were analyzed: inpatients that had been previously followed at the diabetic foot clinic of the hospital and inpatients without a previous contact with the hospital services. A total of 125 isolates obtained from 87 patients were deemed for analysis. Globally, a predominance of Gram-positive bacteria was observed (60%). Staphylococcus aureus was the most common pathogen. The global ratio of methicillin-sensitive S aureus to methicillin-resistant S aureus (MRSA) was 1.3:1, with similar findings in both groups. According to the antibiotic sensitivity test results, and within the recommended empiric antibiotic regimens for DFI, piperacillin/tazobactam seems to be the most suitable option. Gram-positive bacteria prevail as the main isolates in DFIs. Screening for MRSA-specific risk factors is mandatory. When going for a first empiric therapy, piperacillin/tazobactam is recommended in this institution, and an anti-MRSA agent should be added early, if necessary. We encourage continuous monitoring for the bacterial prevalence in Portuguese diabetic foot centers as it is paramount for the decision making regarding DFI protocols.
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Affiliation(s)
- José Miguel Neves
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central
| | - Bruno Duarte
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central
| | - Margarida Pinto
- Microbiology Department, Centro Hospitalar Universitário de Lisboa Central
| | - Ana Formiga
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central
| | - José Neves
- Diabetic Foot Unit, General Surgery Department, Centro Hospitalar Universitário de Lisboa Central
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