Diabetic Foot Infections: Microbiology and Antibiotic Therapy

2012 ◽  
pp. 93-101
Author(s):  
Brian Scully
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Diabetic Foot Infections

Topical Application of a Gentamicin-Collagen Sponge Combined with Systemic Antibiotic Therapy for the Treatment of Diabetic Foot Infections of Moderate Severity

2012 ◽  
Vol 102 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Benjamin A. Lipsky ◽  
Michael Kuss ◽  
Michael Edmonds ◽  
Alexander Reyzelman ◽  
Felix Sigal
Keyword(s):  
Treatment Group ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Clinical Cure ◽  
Standard Of Care ◽  
Collagen Sponge ◽  
Control Group ◽  
Moderate Severity ◽  
Diabetic Foot Infections ◽  
Systemic Antibiotic Therapy

Background: The aim of this pilot study was to determine the safety and potential benefit of adding a topical gentamicin-collagen sponge to standard of care (systemic antibiotic therapy plus standard diabetic wound management) for treating diabetic foot infections of moderate severity. Methods: We randomized 56 patients with moderately infected diabetic foot ulcers in a 2:1 ratio to receive standard of care plus the gentamicin-collagen sponge (treatment group, n = 38) or standard of care only (control group, n = 18) for up to 28 days of treatment. Investigators performed clinical, microbiological, and safety assessments at regularly scheduled intervals and collected pharmacokinetic samples from patients treated with the gentamicin-collagen sponge. Test of cure was clinically assessed 14 days after all antibiotic therapy was stopped. Results: On treatment day 7, we noted clinical cure in no treatment patients and three control patients (P = .017). However, for evaluable patients at the test-of-cure visit, the treatment group had a significantly higher proportion of patients with clinical cure than did the control group (22 of 22 [100.0%] versus 7 of 10 [70.0%]; P =.024). Patients in the treatment group also had a higher rate of eradication of baseline pathogens at all visits (P ≤ .038) and a reduced time to pathogen eradication (P < .001). Safety data were similar for both groups. Conclusions: Topical application of the gentamicin-collagen sponge seems safe and may improve clinical and microbiological outcomes of diabetic foot infections of moderate severity when combined with standard of care. These pilot data suggest that a larger trial of this treatment is warranted. (J Am Podiatr Med Assoc 102(3): 223-232, 2012)

scholarly journals Efficacy of topical vancomycin and gentamicin loaded calcium sulfate beads or systemic antibiotics in eradicating polymicrobial biofilms isolated from diabetic foot infections within an in vitro wound model

2021 ◽  
Author(s):  
G.S. Crowther ◽  
N. Callaghan ◽  
M Bayliss ◽  
A Noel ◽  
R. Morley ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Systemic Therapy ◽  
Diabetic Foot ◽  
Calcium Sulfate ◽  
Antibiotic Administration ◽  
Systemic Delivery ◽  
Management Options ◽  
Diabetic Foot Infections ◽  
Wound Model

Diabetic foot ulcers are notoriously difficult to heal, with ulcers often becoming chronic, in many cases leading to amputation despite weeks or months of antibiotic therapy in addition to debridement and offloading. Alternative wound biofilm management options such as topical rather than systemic delivery of antimicrobials have been investigated by clinicians in order to improve treatment outcomes. Here, we collected blood and tissue from six subjects with diabetic foot infections, measured the concentration of antibiotics in the samples after treatment, and compared the microbiota within the tissue before treatment and after seven days of antibiotic therapy. We used an in vitro model of polymicrobial biofilm infection inoculated with isolates from the tissue we collected to simulate different methods of antibiotic administration by simulated systemic therapy or topical release from calcium sulfate beads. We saw no difference in biofilm bioburden in the models after simulated systemic therapy (representative of antibiotics used in the clinic) but we did see reductions in bioburden of between five and eight logs in five of the six biofilms that we tested with topical release of antibiotics via calcium sulfate beads. Yeast is insensitive to antibiotics and was a component of the sixth biofilm. These data support further studies of topical release of antibiotics from calcium sulfate beads in diabetic foot infections to combat the aggregate issues of infectious organisms taking the biofilm mode of growth, compromised immune involvement and poor systemic delivery of antibiotics via the bloodstream to the site of infection in patients with diabetes.

scholarly journals Optimization of the antibiotic management of diabetic foot infections - Protocol for two randomized controlled trials

2019 ◽  
Author(s):  
Felix WA Waibel ◽  
Martin Berli ◽  
Sabrina Catanzaro ◽  
Kati Sairanen ◽  
Madlaina Schöni ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Adverse Events ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Randomized Clinical Trials ◽  
Antibiotic Use ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Systemic Antibiotic Therapy ◽  
Antibiotic Management

Abstract Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We will perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI. Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is “remission of infection” after a minimal follow-up of two months. The secondary outcomes for both RCT are the incidence of adverse events and the overall treatment costs. The First RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The Second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies. Discussion: Both parellel RCTs will repond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to assure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use. Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4th September 2019. Protocol version: 2 (15th July 2019)

scholarly journals Antibiotic Therapy for Diabetic Foot Infections: Comparison of Two Parenteral-to-Oral Regimens

1997 ◽  
Vol 24 (4) ◽  
pp. 643-648 ◽  
Author(s):  
B. A. Lipsky ◽  
P. D. Baker ◽  
G. C. Landon ◽  
R. Fernau
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Diabetic Foot Infections

scholarly journals Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mingxia Wu ◽  
Hang Pan ◽  
Weiling Leng ◽  
Xiaotian Lei ◽  
Liu Chen ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Drug Susceptibility ◽  
Microbial Culture ◽  
Bacterial Composition ◽  
Microbial Distribution ◽  
Diabetic Foot Infections ◽  
Positive Rate ◽  
Susceptibility Tests ◽  
Composition Ratios

Objective. To investigate the microbial distribution and drug susceptibility among diabetic foot ulcers (DFUs) with different Wagner grades and between acute and chronic DFUs. Methods. We enrolled 428 DFU patients who were hospitalized and treated in the Southwest Hospital. We collected deep ulcer secretion for microbial culture and drug susceptibility tests and analyzed the results. We reexamined 67 patients with poor anti-infection efficacy and analyzed microbial species. Results: The 354 positive samples included 201 cases (56.8%) of single-pathogen infections and 153 cases (43.2%) of multiple-pathogen infections before antibiotic therapy. A total of 555 strains were cultivated, including 205 (36.9%) strains of gram-positive organisms (GPOs), 283 (51.0%) gram-negative bacilli (GNB), and 67 (12.1%) fungal strains. In terms of distribution, patients with different Wagner grades had different bacterial composition ratios (P<0.01). Patients with Wagner grades 3–5 mainly had GNB. The specimens from chronic ulcer wounds were primarily GNB (54.2%), whereas fungi accounted for 14.4% of the infections; the distribution was significantly different from that of acute ulcers (P<0.01). The susceptibility tests showed that the Staphylococcus genus was more susceptible to vancomycin, linezolid, and tigecycline. Tobramycin was the most effective drug (97%) for the treatment of Escherichia coli, followed by ertapenem (96.4%), imipenem (93.5%), and cefotetan (90%). Most of the remaining GNB were susceptible to antibiotics such as carbapenems, aminoglycosides, fluoroquinolones, ceftazidime, cefepime, and piperacillin-tazobactam (>63.2%). After antibiotic therapy, the positive rate of microbial culture was 52.2%, and the proportion of GNB and fungi increased to 68.9% and 20%. Conclusion. The distribution and types of bacteria in diabetic foot infection (DFI) patients varied with the different Wagner classification grades, courses of the ulcers, and antibiotic therapy. Multidrug resistance were increased, and the clinical treatment of DFIs should select the most suitable antibiotics based on the pathogen culture and drug susceptibility test results.

scholarly journals 1422. Evaluation of Diabetic Foot Infections and Osteomyelitis in a Veteran Population: Targets for Improved Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S518-S518
Author(s):  
Michael T Carter ◽  
Grishma Trivedi ◽  
Kristen Fodero ◽  
Bethany A Wattengel ◽  
John Sellick ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Ankle Brachial Index ◽  
Treatment Strategies ◽  
Prolonged Treatment ◽  
Failure Rates ◽  
Diabetic Foot Infections ◽  
Initial Intervention ◽  
Poor Outcomes ◽  
The Impact

Abstract Background Diabetic foot infections (DFI) complicated with osteomyelitis are a difficult infection to treat often resulting in poor outcomes. DFIs often require amputations, including serial amputations due to inadequate initial intervention and infection progression. This study examines various diagnostic and treatment strategies aimed to improve outcomes. Methods This retrospective cohort study included patients greater than or equal to 18 years of age with a DFI as identified via ICD 9 and ICD 10 codes from January 2005 to December 2018. Outcomes were analyzed to measure the impact of baseline characteristics on outcomes. The severity of infection was defined by PEDIS score (perfusion, extent, depth, infection, and sensation). Descriptive statistics were used to report differences. Results One hundred and thirty patients were included, 72% with osteomyelitis. The median PEDIS score was 3 (interquartile range 2–3). Magnetic resonance imaging was used to evaluate 38% of the population. Osteomyelitis patients who had an MRI performed were noted to have a higher rate of appropriate treatment and cure (56%) when compared with a similar group of patients who did not receive an MRI (25%) (P = 0.005). Comparing prolonged (> 4 weeks) therapy to short therapy, there was a significantly higher proportion of cures noted (62.71% vs. 36.62%, P < 0.0001). Failure was associated with less than 4 weeks of therapy (66.7%, P = 0.03) and presence of residual inflammation/infection after amputation (58.3%, P < 0.0001). Route of antibiotic had no impact on failure rates. However, patients with an initial drug-bug mismatch were more likely to fail. Sixty-six percent of patients with decreased ankle brachial index failed (P = 0.02). Conclusion Diabetic foot infections have serious consequences. Over a third of patients required further amputation or additional antibiotic therapy. Risk of failure was associated with short durations of therapy, poor perfusion, and residual inflammation after amputation. However, a higher rate of cures was noted with use of an MRI and prolonged therapy in patients. Stewardship initiatives may wish to focus on ensuring prolonged treatment courses and appropriate surgical intervention rather than on route of antibiotic therapy as there was no difference in failure rates. Disclosures All authors: No reported disclosures.

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