Staphylococcus aureus Pericarditis Presenting as Cardiac Tamponade Caused by Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) remains a significant comorbidity in diabetes and often requires both surgical and medical interventions. Surgical bone resection with proximal margins is performed for treatment at our institution to guide antimicrobial therapy. Optimal antibiotic duration often remains unclear, along with clinical outcomes with negative margins. We evaluate if negative bone margins predict outcomes of DFO at one year in our county hospital. Methods A retrospectively cohort study assessed adult patients undergoing DFO amputations between 9/2016 to 9/2019. Patient data collected included demographics, smoking history, hemoglobin A1c (HbA1c), basic labs, microbiology, antibiotic duration, bone margin pathology. Physician review of records determined if intervention was successful. Primary outcome was met if no further amputation at the same site was required in the following 12 months. Results Of 92 patients, 57 had negative margins and 35 had positive margins for pathology confirmed osteomyelitis. Smoking history was significant in positive margins (35.1% vs 57.1%; p=0.038). Patients with negative margins had a successful outcome at 12 months compared to positive margins (86% vs 66%; p=0.003), but no significant differences in outcome at 6 months. Antibiotic days was reduced in negative margin individuals (mean 18 vs 30 days; p=0.001). Negative margins also demonstrated significant lower rates of readmission at 12 months (p=0.015). Staphylococcus aureus was notable in positive vs negative margins (57.1% vs 29.8%; p=0.017). MSSA was significantly noted in positive margins (45.7% vs 14%; p=0.001). MRSA was similar regardless of margin results (15.8% vs 11.4%; p=0.399). Initial ESR, CRP and HbA1c were similar between groups. Conclusion Our study noted that negative proximal bone margins resulted in more successful outcomes at 12 months and less days of antimicrobial therapy. Patients with negative margins had lower rates of readmission at 12 months for surgical site complications. Negative proximal bone margins results can guide antibiotic therapy and improve outcomes of resections. Presence of S. aureus was significant in positive margins and likely warrant consideration for further aggressive intervention. Clinical Characteristics of Patients with Diabetic Foot Osteomyelitis Clinical demographics, antibiotic usage, microbiology and results of patients presenting for diabetic foot osteomyelitis needing surgical amputation intervention. Abbreviations: HbA1c - Hemoglobin A1c; MSSA - methicillin-susceptible Staphylococcus aureus; MRSA - methicillin-resistant Staphylococcus aureus; CRP -C-reactive protein; ESR - erythrocyte sedimentation rate Disclosures All Authors: No reported disclosures

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Challenges in the Infected Diabetic Foot: Osteomyelitis and Methicillin-Resistant Staphylococcus Aureus

The Foot in Diabetes ◽

10.1002/0470029374.ch14 ◽

2006 ◽

pp. 169-185

Author(s):

Anthony R. Berendt ◽

Benjamin A. Lipsky

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Diabetic Foot Osteomyelitis

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Blood cultures after bone debridement in patients with diabetic foot osteomyelitis

10.26226/morressier.56d6be72d462b80296c97260 ◽

2016 ◽

Author(s):

Paule Letertre-Gibert

Keyword(s):

Diabetic Foot ◽

Blood Cultures ◽

Diabetic Foot Osteomyelitis

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Fungal Infection in Patients With Diabetic Foot Osteomyelitis

Case Medical Research ◽

10.31525/ct1-nct04041739 ◽

2019 ◽

Author(s):

Keyword(s):

Fungal Infection ◽

Diabetic Foot ◽

Diabetic Foot Osteomyelitis

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Inflammatory Biomarkers to Diagnose and Monitor Diabetic Foot Osteomyelitis

Case Medical Research ◽

10.31525/ct1-nct04025853 ◽

2019 ◽

Author(s):

Keyword(s):

Diabetic Foot ◽

Inflammatory Biomarkers ◽

Diabetic Foot Osteomyelitis

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Spectral and Antibiotic Susceptibility of Pathogens Isolated from Saudi Patients with Diabetic Foot Infections

Microbiology Research ◽

10.3390/microbiolres12010002 ◽

2021 ◽

Vol 12 (1) ◽

pp. 16-20

Author(s):

Samiah Hamad S Al-Mijalli

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Antibiotic Susceptibility ◽

Empirical Therapy ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Sensitivity Testing ◽

Cross Sectional ◽

Diabetic Foot Infections ◽

Microbiological Methods

Diabetic foot infections (DFIs) are a significant health issue and a common complication among patients with diabetes. To develop antibiotic therapy for these high-risk patients, the current study evaluates the scope of DFIs and identifies the causing microbes. It also measures spectrum and antibiotic susceptibility of the pathogens isolated from adults with DFIs in Saudi Arabia. To achieve the study objectives, a cross-sectional study was implemented and the baseline characteristics for 44 patients with DFIs were defined. Optimal aerobic and anaerobic microbiological techniques were utilized to culture specimens isolated from infected foot ulcers. The standard microbiological methods were employed to identify the bacterial isolates and antibiotic susceptibility testing was conducted following the procedures of the Clinical and Laboratory Standards Institute (CLSI). Results showed that 12 microorganisms were isolated from the participants’ diabetic foot ulcers. Staphylococcus Aureus was ranked first because it appeared in 29 (65.9%) cases. Streptococcus Agalactiae was ranked second and multi-microbial infections were also found. Most of the organisms were susceptible to Vancomycin, Ciprofloxacin, and Cefalexin, but they were resistant to Methicillin, Gentamicin, and Ampicillin antibiotics. Staphylococcus Aureus was most sensitive to Ciprofloxacin, while it was resistant to Methicillin. About 10% of the isolates were multidrug-resistant. The study concludes that while Vancomycin should be used empirically for Gram-positive isolates, Ciprofloxacin can be taken into consideration for most of the Gram-negatives aerobes. Based on including various microorganisms and the advent of multidrug-resistant strains, proper culture and sensitivity testing are necessary prior to the empirical therapy.

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318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.514 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S231-S232

Author(s):

Shiwei Zhou ◽

Brian M Schmidt ◽

Oryan Henig ◽

Keith S Kaye

Keyword(s):

Diabetic Foot ◽

Medical Management ◽

Wound Care ◽

Cohort Analysis ◽

Severity Of Illness ◽

Complete Healing ◽

Knee Amputation ◽

Management Group ◽

One Year ◽

Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation. Methods An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured. Results Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation. One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017). Conclusion In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended. Disclosures All Authors: No reported disclosures

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Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana

Pathogens ◽

10.3390/pathogens10080937 ◽

2021 ◽

Vol 10 (8) ◽

pp. 937

Author(s):

Ramzy B. Anafo ◽

Yacoba Atiase ◽

Nicholas T. K. D. Dayie ◽

Fleischer C. N. Kotey ◽

Patience B. Tetteh-Quarcoo ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Multidrug Resistance ◽

Teaching Hospital ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Coagulase Negative Staphylococci ◽

Methicillin Resistant ◽

Mrsa Infection

Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors predisposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli (24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca (11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S. aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%, n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%, n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029, p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance was high, highlighting the need to further intensify antimicrobial stewardship programmes.

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