Surveillance of Enterobacteriaceae from Diabetic Foot Infections in a Tunisian Hospital: Detection of E. coli-ST131-blaCTX-M-15 and K. pneumoniae-ST1-blaNDM-1 Strains

The study determined the prevalence, antimicrobial resistant (AMR) determinants, and genetic characteristics of Escherichia coli and Klebsiella pneumoniae isolates from patients with diabetic foot infection (DFI) in a Tunisian hospital. A total of 26 Escherichia spp. and Klebsiella spp. isolates were recovered and identified by MALDI-TOF-MS. Antimicrobial susceptibility testing, the detection of AMR determinants and Shiga-like toxin genes, phylogenetic grouping, and molecular typing were performed. Twelve E. coli, 10 K. pneumoniae, 3 K. oxytoca, and 1 E. hermanii were isolated. A multidrug-resistant phenotype was detected in 65.4% of the isolates. About 30.8% of isolates were extended-spectrum β-lactamase (ESBL) producers and mainly carried blaCTX-M-15 and blaCTX-M-14 genes. One blaNDM-1-producing K. pneumoniae-ST1 strain was identified. Class 1 integrons were detected in 11 isolates and 5 gene cassette arrangements were noted: dfrA1+aadA1 (n = 1), dfrA12+aadA2 (n = 3), and dfrA17+aadA5 (n = 1). Other non-β-lactam resistance genes detected were as follows (number of isolates): aac(3')-II (3), aac(6')-Ib-cr(8), qnrB (2), qnrS (4), cmlA (2), floR (4), sul1 (11), sul2 (11), and sul3 (2). The phylogroup B1 was the most frequent (41.7%) among E. coli, and two ESBL-producing isolates corresponded to the ST131-B2 lineage. The ESBL- and carbapenemase-producing Enterobacteriaceae in DFIs are described for the first time in Tunisia.

Developing and Establishing a Wound Dressing Team: Experience and Recommendations

BACKGROUND

The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of wound-dressing teams for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound-dressing team by reporting our experiences with the establishment of a wound-dressing team.

METHODS

The wound-dressing team was established at Korea University Guro Hospital. Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wound-dressing team. The data were analyzed to assess the types of wounds and their outcomes. In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members.

RESULTS

Regarding the wound type, 80,297 (45.3%) were catheter-related, while 48,036 (27.1%), 26,056 (14.7%), and 20,739 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores of the patient, ward nurse, dressing team nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively. Additionally, 136 dressing-related complications (0.08%) were reported.

CONCLUSION

The wound dressing team can enhance satisfaction among patients and healthcare providers with low complications. Our findings may provide a potential framework for establishing similar service models.

Diabetic Foot Infection Characteristics and Antibiotics Susceptibility Patterns in a Regional Hospital in Libya

Introduction Diabetes is a major global health problem, among the top causes of death worldwide. Diabetic foot infection (DFI) is associated with an increased risk of amputation by 155 times and a mortality rate of 57% at 5 years. This study aims to characterize DFI epidemiology in a local hospital and analyze local microbiological patterns and antibiotic susceptibility testing.

Patients and Methods This is a retrospective review of Al Jala hospital Benghazi/Libya medical records. Eligible patients were included, if they had DFI with confirmed tissue/pus samples collections was submitted to the hospital laboratory for microbiology and Antibiotics susceptibility analysis.

Results Out of 126 patients, 77 (61.1%) were men, and 49 (38.9%) were women. The mean age was 55.4 years. Incision drainage with debridement was the most common surgical procedure (77.1%). 38.88% of growth was polymicrobial. Gram-negative rods were isolated in 70.9%, and gram-positive cocci in 27.4%. The most commonly isolated bacteria were Pseudomonas aeruginosa (15.9%) and Proteus sps. (14.2%), Staphylococcus aureus (11.3%), and Escherichia coli (10.2%). Methicillin-resistant Staphylococcus aureus (MRSA) constitutes 30% of isolated S. aureus. The most common effective antibiotic for P. aeruginosa was imipenem (90%), for S. aureus was linezolid (100%), and for MRSA was linezolid, vancomycin (100%), and ciprofloxacin 88.8%. Sixty-four percent of total bacterial isolates were MDROs (gram-positive isolates 65.3%, gram-negative isolates 63.6%).

Conclusions The emergence of antibiotic-resistant bacteria is a global health concern. This study attempts to evaluate the local microbiology and antimicrobial susceptibility to tailor the treatment choice for better patient outcomes.

Predictors and outcomes of diabetic foot ulcer infection with ESBL-producing bacteria in a large tertiary center

OBJECTIVES

The aim of this study was to describe the predictors and outcomes of infection with extended-spectrum beta-lactamase (ESBL)-producing bacteria in patients with an acute diabetic foot infection (DFI).

METHODS

The records of patients admitted with acute DFI to a large tertiary hospital during the years 2014-2018 were reviewed. Demographic, clinical, and laboratory data were collected, as well as outcomes regarding amputations and mortality. Only cultures obtained during the first 2 weeks following admission were considered.

RESULTS

Cultures were available for 493 patients; 121 (24.5%) included bacteria suspected of being ESBL producers. Patients infected with ESBL-producing bacteria were older, more likely to have peripheral vascular disease (PVD), and had higher SINBAD and Wagner scores upon admission. They were also more likely to have been hospitalized in the recent 6 months. Major amputations were more prevalent in patients with versus without an ESBL-producing bacterial infection (30.6% vs 19.4%; P = 0.010), yet overall amputations and mortality rates were similar.

CONCLUSIONS

ESBL-producing bacteria are common pathogens in DFI, more prevalent in older patients with PVD, advanced ulcers, and recent hospitalization. They are associated with higher rates of major amputation. These considerations may support the choice of empirical antibiotic therapy in patients admitted with an acute DFI.

Diabetic Foot Infections: Bacterial Isolates From the Centers and Hospitals of Latin American Countries

Diabetic foot infections (DFIs) are one of the most important reasons for lower limb amputations. An adequate approach to the management of DFI implies control of infection using strategies of tissue debridement and empirical antibiotic treatment based on local microbiology. The aim of this study was to determine the bacterial isolates profile and antibiotic susceptibility patterns in samples from DFI from Latin American centers, on the premise that microbiology of this region differs from that of other continents and influences antimicrobial election. Three hundred and eighty-two samples from soft tissue and bone were studied from 17 centers of 4 countries. Three hundred and seven (80.4%; 95% confidence interval = 75.9-84.2) were positive. Gram negatives (GN) were isolated in 43.8% of all samples, not only in severe but also in mild infections, 51% in bone samples, more frequently in presence of ischemia (47% vs 38%; P = .07) and in wounds with longer duration of the lesion (30-20 days; P < .01). Staphylococcus aureus was the most frequent single germ (19.9%). Gram positives were isolated more frequently in patients without ischemia (53% vs 40%; P = .01). Enterococcus faecalis was the most frequent germ in bone samples (16.8%). Ciprofloxacin and trimethoprim-sulfamethoxazole were the oral antimicrobials most effective against GN. Trimethoprim-sulfamethoxazole and rifampicin were the oral antimicrobials most effective against Staphylococcus. Because of GN high antibiotic resistance patterns, patients treated in an ambulatory setting have to be controlled early after starting empiric treatment to assess response to therapy and hospitalize for parenteral antibiotics if oral treatment fails.

Microbiology and Antimicrobial Therapy for Diabetic Foot Infections

In addition to being the prime factor associated with amputation, diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, and reduced quality of life. The choice of appropriate antibiotics is very important in order to reduce treatment failure, antimicrobial resistance, adverse events, and costs. We reviewed articles on microbiology and antimicrobial therapy and discuss antibiotic selection in Korean patients with DFIs. Similar to Western countries, Staphylococcus aureus is the most common pathogen, with Streptococcus, Enterococcus, Enterobacteriaceae and Pseudomonas also prevalent in Korea. It is recommended that antibiotics are not prescribed for clinically uninfected wounds and that empirical antibiotics be selected based on the clinical features, disease severity, and local antimicrobial resistance patterns. Narrow-spectrum oral antibiotics can be administered for mild infections and broad-spectrum parenteral antibiotics should be administered for some moderate and severe infections. In cases with risk factors for methicillin-resistant S. aureus or Pseudomonas, empirical antibiotics to cover each pathogen should be considered. The Health Insurance Review and Assessment Service standards should also be considered when choosing empirical antibiotics. In Korea, nationwide studies need to be conducted and DFI guidelines should be developed.