Diabetic Foot Infections

2016 ◽  
Author(s):  
Clare Kelleher
Keyword(s):  
Diabetic Foot ◽  
Prior History ◽  
Diabetic Foot Infections ◽  
Definitive Therapy ◽  
Empiric Antibiotic ◽  
History Of ◽  
Mrsa Infection ◽  
Systemic Manifestations ◽  
Purulent Drainage ◽  
Incision Drainage

Diabetic foot infections (DFI) are diagnosed by two or more classic findings of inflammation (redness, swelling, warmth, and tenderness) or purulent drainage within an existing diabetic foot wound. Wounds without clinical evidence of soft tissue or bone infection often do not require antibiotic therapy. When infection is present, empiric antibiotic regimens must be based on the available clinical and local epidemiologic data, but definitive therapy should be based on cultures of infected tissues or clinical response. Consideration of methicillin-resistant Staphylococcus aureus (MRSA) coverage should be given when local prevalence is high, in patients with a prior history of MRSA infection, or when the systemic manifestations are severe. Surgical intervention and vascular assessment play key roles in the management of many DFI; deep DFI require incision, drainage, and debridement. Redistribution of pressure off of the wound is a tenet in the management of DFI.

Antimicrobial therapy in infectious complications of diabetic foot

2014 ◽  
Vol 21 (1) ◽  
pp. 55-62
Author(s):  
Ioan Marin ◽  
Roxana Zaharia ◽  
Leonard Lupu ◽  
Emilia Rusu ◽  
Gabriela Radulian
Keyword(s):  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Infectious Complications ◽  
Wound Management ◽  
Successful Outcome ◽  
Surgical Interventions ◽  
Diabetic Foot Infections ◽  
Definitive Therapy ◽  
Peripheral Arterial

Abstract Background and aims: The treatment of diabetic foot complications is combined, surgical and medical. The aim of our study was to assess the results of antimicrobial therapy in diabetic foot infections. Material and methods: 100 patients with diabetic foot infections admitted in the Surgery Clinic “I. Juvara” between December 2010 and February 2011 were analyzed. Results: Mean age at presentation was 58.4±9.74 years for women and 63.2±10.53 years for men. Mean diabetes duration was 12.3 years in men and 15.7 years in women. Patients with peripheral arterial disease represented 45% of cases, patients with neuropathy represented 16% of cases and patients with both conditions 39% of the cases. 41 patients suffered minor surgical interventions, 36 patients experienced minor amputations and 23 major amputations (below or above the knee). Antibiotic treatment included cephalosporins, fluoroquinolones and combinations with Metronidazole. After treatment, 74% of patients had a good postoperative evolution. For 26 patients a change of the antibiotic was necessary but only in 10 cases this was made according to antibiogram. Conclusions: Surgical debridement and wound management, carefully chosen antimicrobial therapy and treatment of comorbidities are very important for a successful outcome. Initial empirical antibiotic selection should be followed by culture-guided definitive therapy.

Correlation Between Patients With Methicillin-Resistant Staphylococcus aureus (MRSA) Nares Colonization and MRSA Diabetic Foot Infections

2020 ◽  
pp. 153473462096357
Author(s):  
Jacquelyn Brondo ◽  
Kathleen Morneau ◽  
Teri Hopkins ◽  
Linda Yang ◽  
Jose Cadena-Zuluaga ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Predictive Value ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Empiric Therapy ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections ◽  
Prior Literature ◽  
Mrsa Infection

Infectious Diseases Society of America diabetic foot infection (DFI) guidelines indicate empiric methicillin-resistant Staphylococcus aureus (MRSA) coverage for patients with a history of MRSA infection, when local prevalence of MRSA is high, or infection is clinically severe. These recommendations may lead to overutilization of empiric MRSA coverage, which can result in serious consequences. A strong negative predictive value (NPV) has been reported in literature for pneumonia, and recently, for all anatomical sites of infection. While these findings are promising, further validation is needed before clinicians may confidently use MRSA nares to guide empiric therapy for DFIs. A retrospective electronic medical record review was completed between October 1, 2013 and October 1, 2019. Patients met inclusion criteria if they were at least 18, admitted with a DFI, had MRSA nares test results, and DFI cultures. Patients were excluded if pregnant or MRSA infection within 1 year prior to index admission for DFI. A total of 200 patients met inclusion criteria. The majority of study participants were male with a mean age of 63. NPV of MRSA nares for MRSA DFIs was determined to be 94% and positive predictive value 58%. Sensitivity and specificity were 56% and 94%, respectively. Results of this study are consistent with prior literature supporting strong correlation of NPV for MRSA nares. The DFIs evaluated suggest a strong NPV of MRSA nares for MRSA DFIs, which may allow for faster de-escalation of empiric anti-MRSA antibiotic therapy and lower risk of adverse events associated with anti-MRSA therapy.

Routine Screening for Methicillin-ResistantStaphylococcus AureusAmong Patients Newly Admitted to an Acute Rehabilitation Unit

2002 ◽  
Vol 23 (9) ◽  
pp. 516-519 ◽  
Author(s):  
Farrin A. Manian ◽  
Diane Senkel ◽  
Jeanne Zack ◽  
Lynn Meyer
Keyword(s):  
Relative Yield ◽  
Prior History ◽  
Current Profile ◽  
Rehabilitation Unit ◽  
History Of ◽  
Mrsa Infection ◽  
Low Prevalence ◽  
Time Of Admission ◽  
Acute Rehabilitation ◽  
Mrsa Colonization

Background:Following an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.Objectives:To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.Methods:Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.Results:The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P= .0009) for newly admitted patients and from 0% to 7% (P< .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.Conclusion:The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

scholarly journals 110. MRSA nasal swab as a stewardship tool to guide IV Vancomycin in diabetic foot infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S169-S170
Author(s):  
Alex Lazo-Vasquez ◽  
Michael Piazza ◽  
Leopoldo Cordova ◽  
Lauren Bjork ◽  
Rolando A Zamora Gonzalez ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Nasal Swab ◽  
Positive Culture ◽  
Diabetic Foot Infections ◽  
Medication Utilization ◽  
Stewardship Program ◽  
Screen Result ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
Mrsa Infection

Abstract Background The Infectious Disease Society of America (IDSA) guidelines suggest empiric Methicillin-Resistant Staphylococcus Aureus (MRSA) coverage for Diabetic Foot Infection (DFI) with a history of MRSA infection, if local prevalence is high, or if the infection is severe. However, data suggests that there is overutilization of vancomycin in this population and this medication is associated with toxicity. MRSA nasal screen has a high negative predictive value (NPV) for ruling out MRSA in pneumonia and other sites. We performed a medication utilization evaluation (MUE) for Vancomycin IV in DFI patients who had an MRSA nares screen to determine our own NPV of this test and feasibility to use it as an antibiotic stewardship program (ASP) tool to guide vancomycin use in this population. Methods We retrospectively reviewed 224 patients from January 2015 to January 2020 who had a diagnosis of DFI and an MRSA nasal screen. 139 patients had cultures done. For the NPV, we excluded patients who had any MRSA positive culture or screen up to a year from admission (Figure 1). Figure 1. Flowchart from our medication utilization evaluation showing patient’s distribution by MRSA-screen result Results We found 148 (66%) patients with DFI who had received IV vancomycin empirically during the admission and 196 of them were MRSA-nares negative (Figure 2). The average days of therapy (DOT) in the MRSA-nares negative patients was 5.2 days vs 4.8 in the MRSA-nares positive patients. Out of the 139 patients with a negative MRSA nasal swab, 124 had no MRSA in cultures, yielding an NPV of 89%. If we considered only the deep cultures, the NPV increased to 90%. Figure 2. Number of patients who received IV vancomycin grouped by MRSA-screen result Conclusion We identified overutilization of IV vancomycin in patients with a diagnosis of DFI in our institution. Also, our NPV of the MRSA-nasal screening to rule out MRSA infection in DFI was high at 89% similar to previous studies. Based on these findings, we plan to implement a local ASP protocol (Figure 3) using MRSA nasal swab screen to decrease the empiric use of vancomycin. The results of these efforts will be analyzed and published in future iterations with the hopes to share this knowledge to reduce the use of IV vancomycin in this population in other centers. Figure 3. Protocol draft to be used as an ASP tool to guide IV vancomycin de-escalation based on MRSA-nasal screen for DFI patients Disclosures All Authors: No reported disclosures

Identifying the Risk Factors for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection among Patients Colonized with MRSA on Admission

2012 ◽  
Vol 33 (12) ◽  
pp. 1219-1225 ◽  
Author(s):  
Yuriko Fukuta ◽  
Candace A. Cunningham ◽  
Patricia L. Harris ◽  
Marilyn M. Wagener ◽  
Robert R. Muder
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Prior History ◽  
Methicillin Resistant ◽  
Control Subjects ◽  
History Of ◽  
Mrsa Infection ◽  
Hospital Acquired

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospital-acquired infections. MRSA-colonized inpatients who may benefit from undergoing decolonization have not been identified.Objective.To identify risk factors for MRSA infection among patients who are colonized with MRSA at hospital admission.Design.A case-control study.Setting.A 146-bed Veterans Affairs hospital.Participants.Case patients were those patients admitted from January 2003 to August 2011 who were found to be colonized with MRSA on admission and then developed MRSA infection. Control subjects were those patients admitted during the same period who were found to be colonized with MRSA on admission but who did not develop MRSA infection.Methods.A retrospective review.Results.A total of 75 case patients and 150 control subjects were identified. A stay in the intensive care unit (ICU) was the significant risk factor in univariate analysis (P<.001). Prior history of MRSA (P = .03), transfer from a nursing home (P = .002), experiencing respiratory failure (P<.001), and receipt of transfusion (P = .001) remained significant variables in multivariate analysis. Prior history of MRSA colonization or infection (P = .02), difficulty swallowing (P = .04), presence of an open wound (P = .002), and placement of a central line (P = .02) were identified as risk factors for developing MRSA infection for patients in the ICU. Duration of hospitalization, readmission rate, and mortality rate were significantly higher in case patients than in control subjects (P< .001, .001, and <.001, respectively).Conclusions.MRSA-colonized patients admitted to the ICU or admitted from nursing homes have a high risk of developing MRSA infection. These patients may benefit from undergoing decolonization.

2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infectionsa

2013 ◽  
Vol 103 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Benjamin A. Lipsky ◽  
Anthony R. Berendt ◽  
Paul B. Cornia ◽  
James C. Pile ◽  
Edgar J. G. Peters ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Empiric Antibiotic Therapy ◽  
Diabetic Patients ◽  
Bone Culture ◽  
Healthcare Organizations ◽  
Surgical Interventions ◽  
Diabetic Foot Infections ◽  
Empiric Antibiotic ◽  
Severe Infections

Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds. Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy. For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture. Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens. Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific. Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy). Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation). Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up. An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures. Employing multidisciplinary foot teams improves outcomes. Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs.

scholarly journals Challenges of Applying the SHEA/HICPAC Metrics for Multidrug-Resistant Organisms to a Real-World Setting

2011 ◽  
Vol 32 (4) ◽  
pp. 323-332 ◽  
Author(s):  
E. Yoko Furuya ◽  
Elaine Larson ◽  
Timothy Landers ◽  
Haomiao Jia ◽  
Barbara Ross ◽  
...  
Keyword(s):  
At Risk ◽  
Real World ◽  
Multidrug Resistant ◽  
Prior History ◽  
Real World Setting ◽  
Significant Difference ◽  
Multidrug Resistant Organisms ◽  
History Of ◽  
Mrsa Infection ◽  
Not At Risk

Objective.To test in a real-world setting the recommendations for measuring infection with multidrug-resistant organisms (MDRO) from the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC).Methods.Using data from 3 hospital settings within a healthcare network, we applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. Data were obtained from the hospitals' electronic surveillance system and were supplemented by manual medical record review as necessary. Additionally, we tested (1) different definitions for nosocomial incidence, (2) the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and (3) the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates. Negative binomial regression models were used to test for differences between rate definitions. A rating scale was created for each metric, assessing the extent to which manual or electronic data elements were required.Results.There was no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years' worth of prior data.Conclusions.The SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. We include in our description of the data sources and processes required to calculate these metrics information that may simplify the process for institutions.

scholarly journals Case Report: Late onset of generalized isomorphic morphea in a postmenopausal woman

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 107
Author(s):  
Marie Angelique Lazo-Betetta ◽  
Renzo Perez-Vasquez ◽  
Arantxa Sanchez-Boluarte ◽  
Fiorella Inga-Berrospi ◽  
J. Antonio Grandez-Urbina
Keyword(s):  
Case Report ◽  
Postmenopausal Woman ◽  
Skin Biopsy ◽  
Female Patient ◽  
Topical Treatment ◽  
Late Onset ◽  
Skin Condition ◽  
Prior History ◽  
History Of ◽  
Systemic Manifestations

Morphea is an inflammatory, sclerosing skin condition of unknown cause that generally does not present systemic manifestations. A 66-year-old Caucasian Peruvian female patient, who was previously a nurse, presented with a prior history of 4 years of indurated dermal plaque lesions with constant progression. Diagnosis of morphea was made by clinical examination and skin biopsy. The patient started topical treatment with methoxsalen and phototherapy. When no improvement was seen, it was switched to methotrexate. However, due to changes in liver profile, phototherapy was restarted with progressive clinical improvement. It is essential to differentiate all morphea subtypes for proper management.

Risk Factors for Infection with Pseudomonas aeruginosa in Diabetic Foot Infections

2017 ◽  
Vol 107 (6) ◽  
pp. 483-489 ◽  
Author(s):  
Bulent M. Ertugrul ◽  
Benjamin A. Lipsky ◽  
Mevlut Ture ◽  
Serhan Sakarya
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Statistical Significance ◽  
Empirical Therapy ◽  
Wound Dressings ◽  
Factors Affecting ◽  
Diabetic Foot Infections ◽  
History Of ◽  
Epidermal Growth

Background: Selecting empirical therapy for a diabetic foot infection (DFI) requires knowing how likely infection with Pseudomonas aeruginosa is in a particular patient. We designed this study to define the risk factors associated with P aeruginosa in DFI. Methods: We performed a preplanned microbiological subanalysis of data from a study assessing the effects of treatment with intralesional epidermal growth factor for diabetic foot wounds in patients in Turkey between January 1, 2012, and December 31, 2013. Patients were screened for risk factors, and the data of enrolled individuals were recorded in custom-designed patient data forms. Factors affecting P aeruginosa isolation were evaluated by univariate and multivariate logistic regression analyses, with statistical significance set at P &lt; .05. Results: There were 174 patients enrolled in the main study. Statistical analysis was performed in 90 evaluable patients for whom we had microbiological assessments. Cultures were sterile in 19 patients, and 89 bacterial isolates were found in the other 71. The most frequently isolated bacteria were P aeruginosa (n = 23, 25.8%) and Staphylococcus aureus (n = 12, 13.5%). Previous lower-extremity amputation and a history of using active wound dressings were the only statistically significant independent risk factors for the isolation of P aeruginosa in these DFIs. Conclusions: This retrospective study provides some information on risk factors for infection with this difficult pathogen in patients with DFI. We need prospective studies in various parts of the world to better define this issue.

scholarly journals Epidemiology of the Diabetic Foot Infection in a Tertiary Care Hospital in the Lebanon: A Retrospective Study between 2000 and 2011

2018 ◽  
Vol 2 (3) ◽  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Retrospective Study ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Care Hospital ◽  
Complications Of Diabetes ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
History Of

Objectives: Describe the epidemiology of diabetic foot infections in Lebanon as well as the demographic and clinical characteristics of the patients. Study the microbiology of the infections and the bacterial resistances in the infected diabetic foot ulcers, in order to help reach an optimal care in the healthcare establishments. Materials and methods: A retrospective study between January, 2000 and Mars, 2011 of medical cases of 167 hospitalized patients for diabetic foot infection at the Hospital Hôtel-Dieu of France in Beirut, Lebanon. Results: The average age of the patients was 66 years, and males represented 73.65 %. The duration of diabetes was 20 years with a percentage of HbA1C >7 % in 79 % of the cases. 73.17 % of the patients had peripheral arteriopathy, 72.3 % peripheral neuropathy. Other complications of diabetes were associated: coronary problems (49.69 %), retinopathy (48.67 %) and renal disease (47.65 %). High blood pressure was found in 60.38 % of the cases, dyslipidemia in 48.73 %. Pseudomonas aeruginosa was the most frequently isolated bacteria from diabetic foot infections (19.15 %), followed by Escherichia coli (11.91 %), Staphyloccocus aureus (11.06 %), and of Enteroccocus fecalis (11.06 %). Most prescribed antibiotics were: pipéracllin/tazobactam, amoxicillin/clavulanic acid, and imipenme. Amputation was necessary in 36.3 % of the cases. The main risk factors of amputation, besides the infection itself, were history of amputation and arteriopathy Conclusion: In the Lebanese population, the diabetic foot disease takes the aspect of pathology with male ascendancy, which affects, late in their lives, patients with a long-time, badly controlled diabetes. Often, several complications of diabetes are present associated, in particular arteriopathy and peripheral neuropathy. Pseudomonas aeruginosa was the most frequently isolated bacteria from diabetic foot infections in Lebanon. The amputation rate remains high: 36.3 %, with arteriopathy and history of amputation as risk factors.

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