scholarly journals Risk Factors for Pseudomonas aeruginosa in Diabetic Foot Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S108-S108 ◽  
Author(s):  
Nada Farhat ◽  
Daniel McClung ◽  
Jerod Nagel
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Treatment Options ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Current Smoker ◽  
Retrospective Case ◽  
Diabetic Foot Infections ◽  
Severe Infections

Abstract Background Infectious Diseases Society of America guidelines for the management of diabetic foot infections (DFIs) suggest 15 different antibiotic treatment options for moderate-to-severe infections. All treatment options provide coverage for Gram-positive cocci, and some provide coverage for Gram-negative pathogens, including Pseudomonas aeruginosa (PSA). However, there is minimal guidance in determining which patients require anti-PSA therapy. Methods This single-center retrospective case–control study included patients hospitalized between October 2013 and September 2015. Adult patients admitted with a DFI were identified using a combination of ICD-9 codes for diabetes with complications and cellulitis. The primary outcome was identification of risk factors associated with PSA DFIs. A multivariable model using logistic regression was constructed, and a receiver operator characteristic (ROC) curve was generated to assess the sensitivity and specificity of the model. Results 262 patients were included and 12 (4.6%) patients had cultures with PSA. Multivariable analysis yielded six risk factors for PSA DFIs (see Table). ROC construction yielded an area under the curve of 0.895. Conclusion The incidence of PSA from DFIs is low. A model with excellent performance characteristics demonstrated that risk factors for PSA DFIs include age > 65, BMI ≥ 35, former or current smoker, history of lower extremity bypass procedure, and cardiovascular disease. Future validation of these factors could help stewardship programs reduce unnecessary antibiotic utilization. Disclosures All authors: No reported disclosures.

scholarly journals Diabetic Foot Infections: Local Prevalence of and Case–Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Justin J Kim ◽  
Alison Lydecker ◽  
Rohini Davé ◽  
Jacqueline T Bork ◽  
Mary-Claire Roghmann
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections ◽  
Control Study

Abstract We identified deep diabetic foot infections by culture and conducted a case–control study examining the risk factors for moderate to severe methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) diabetic foot infections. Our MRSA prevalence was lower than literature values; PsA was higher. Gangrene may be predictive of Pseudomonas infection.

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 < .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.

Assessing Diabetic Foot Infections With the ThermoScale: A Comparative Thermometry Device Designed as a Patient Self-Screening Tool

2020 ◽  
pp. 153473462094830
Author(s):  
Laure Arts ◽  
Johan De Neve ◽  
Samira Baharlou ◽  
Nathalie Denecker ◽  
Laura Kerselaers ◽  
...  
Keyword(s):  
Temperature Measurement ◽  
Diabetic Foot ◽  
Characteristic Curve ◽  
Screening Method ◽  
Area Under The Curve ◽  
Control Group ◽  
Measurement Technology ◽  
Diabetic Patients ◽  
Home Setting ◽  
Diabetic Foot Infections

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet. Temperature differentials in DFI patients (n = 52) were compared with a control group of similar diabetic patients (n = 45) without any foot wounds. Based on these findings, we drafted a receiver operating characteristic curve to determine an area-under-the-curve of 0.8455. This value suggests that the ThermoScale, as a diagnostic test, is reasonably accurate. A cutoff value of 2.15 °C temperature difference corresponded with a sensitivity of 88.9% and a specificity of 61.5%. As wearables, portable health electronics, and telemedicine become increasingly popular, we think that comparative temperature measurement technology is valuable in improving early diagnosis of DFIs.

scholarly journals Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

2019 ◽  
Vol 112 (7) ◽  
pp. 720-727 ◽  
Author(s):  
Lucas K Vitzthum ◽  
Paul Riviere ◽  
Paige Sheridan ◽  
Vinit Nalawade ◽  
Rishi Deka ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cancer Survivors ◽  
Critical Role ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Multivariable Logistic Regression Model ◽  
Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

Risk Factors for Ventilator-associated Pneumonia by Pseudomonas aeruginosa  in Presence of Recent Antibiotic Exposure

2006 ◽  
Vol 105 (4) ◽  
pp. 709-714 ◽  
Author(s):  
Jordi Rello ◽  
Camilla Allegri ◽  
Alejandro Rodriguez ◽  
Loreto Vidaur ◽  
Gonzalo Sirgo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Relative Risk ◽  
Confidence Interval ◽  
Early Onset ◽  
Late Onset ◽  
Interquartile Range ◽  
Ventilator Associated Pneumonia ◽  
Antibiotic Exposure ◽  
Retrospective Case

Background To facilitate the decision-making process for therapy and prevention of ventilator-associated pneumonia (VAP) in patients undergoing recent antibiotic exposure, this study investigated whether the development of VAP episodes caused by Pseudomonas aeruginosa or other pathogens are related to different risk factors, thereby distinguishing two risk population for this serious complication. Methods A 5-year retrospective case-control observational study was conducted. Cases of VAP caused by P. aeruginosa were compared with those caused by other pathogens. Univariate and multivariate analysis was performed using SPSS 11.0 software (SPSS Inc., Chicago, IL). Results Two groups were identified: P. aeruginosa (group P) was isolated in 58 (63.7%) episodes, and 33 episodes served as controls (group C), after a median of 12 days (interquartile range, 4-28 days) and 9 days (interquartile range, 3-12.5 days) of mechanical ventilation, respectively. P. aeruginosa was identified in 34.7% of episodes with early-onset pneumonia and in 73.5% with late-onset pneumonia. In a logistic regression analysis, P. aeruginosa was independently associated with duration of stay of 5 days or longer (relative risk = 3.59; 95% confidence interval, 1.04-12.35) and absence of coma (relative risk = 8.36; 95% confidence interval, 2.68-26.09). Risk for pathogens different from P. aeruginosa (group C) in early-onset pneumonia associated with coma was estimated to be 87.5%. Conclusions Risk factors in episodes under recent antibiotic treatment caused by P. aeruginosa or other microorganism are not the same, a fact that could have implications for preventive and therapeutic approaches for this infection.

scholarly journals Risk factors for methicillin-resistant Staphylococcus aureus in diabetic foot infections

2014 ◽  
Vol 5 (1) ◽  
pp. 23575 ◽  
Author(s):  
Lawrence A. Lavery ◽  
Javier La Fontaine ◽  
Kavita Bhavan ◽  
Paul J. Kim ◽  
Jayme R. Williams ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections

scholarly journals Hypertonic glucose inhibits growth and attenuates virulence factors of multidrug-resistant Pseudomonas aeruginosa

2020 ◽  
Author(s):  
Tao Chen ◽  
Ye Xu ◽  
Wenya Xu ◽  
Wenli Liao ◽  
Chunquan Xu ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Virulence Factors ◽  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Wound ◽  
Multidrug Resistant ◽  
Wound Infections ◽  
Hypertonic Glucose ◽  
Diabetic Foot Infections ◽  
Chronic Wound Infections

Abstract Background: Pseudomonas aeruginosa is the most common Gram-negative pathogen responsible for chronic wound infections, such as diabetic foot infections, and further exacerbates the treatment options and cost of such conditions. Hypertonic glucose, a commonly used prolotherapy solution, can accelerate the proliferation of granulation tissue and improve microcirculation in wounds. However, the action of hypertonic glucose on bacterial pathogens that infect wounds is unclear. In this study, we investigated the inhibitory effects of hypertonic glucose on multidrug-resistant P. aeruginosa strains isolated from diabetic foot infections. Hypertonic glucose represents a novel approach to control chronic wound infections caused by P. aeruginosa. Results: Four multidrug-resistant P. aeruginosa clinical strains isolated from diabetic foot ulcers from a tertiary hospital in China and the reference P. aeruginosa PAO1 strain were studied. Hypertonic glucose significantly inhibited the growth, biofilm formation, and swimming motility of P. aeruginosa clinical strains and PAO1. Furthermore, hypertonic glucose significantly reduced the production of pyocyanin and elastase virulence factors in P. aeruginosa. The expression of major quorum sensing genes (lasI, lasR, rhlI, and rhlR) in P. aeruginosa were all downregulated in response to hypertonic glucose treatment. In a Galleria mellonella larvae infection model, the administration of hypertonic glucose was shown to increase the survival rates of larvae infected by P. aeruginosa strains (3/5).Conclusions: Hypertonic glucose inhibited the growth, biofilm formation, and swimming motility of P. aeruginosa, as well as reduced the production of virulence factors and quorum sensing gene expression. Further studies that investigate hypertonic glucose therapy should be considered in treating chronic wound infections.

scholarly journals Combined Resistance to Ceftolozane-Tazobactam and Ceftazidime-Avibactam in Extensively Drug-Resistant (XDR) and Multidrug-Resistant (MDR) Pseudomonas aeruginosa: Resistance Predictors and Impact on Clinical Outcomes besides Implications for Antimicrobial Stewardship Programs

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1224
Author(s):  
Marianna Meschiari ◽  
Gabriella Orlando ◽  
Shaniko Kaleci ◽  
Vincenzo Bianco ◽  
Mario Sarti ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Stewardship ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Attributable Mortality ◽  
Retrospective Case ◽  
Comorbidity Score ◽  
Charlson Comorbidity Score ◽  
Clinical Surveillance

A retrospective case-control study was conducted at Modena University Hospital from December 2017 to January 2019 to identify risk factors and predictors of MDR/XDR Pseudomonas aeruginosa (PA) isolation with resistance to ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T), and of mortality among patients infected/colonized. Among 111 PA isolates from clinical/surveillance samples, 60 (54.1%) were susceptible to both drugs (S-CZA-C/T), while 27 (24.3%) were resistant to both (R-CZA-C/T). Compared to patients colonized/infected with S-CZA-C/T, those with R-C/T+CZA PA had a statistically significantly higher Charlson comorbidity score, greater rate of previous PA colonization, longer time before PA isolation, more frequent presence of CVC, higher exposure to C/T and cephalosporins, longer hospital stay, and higher overall and attributable mortality. In the multivariable analysis, age, prior PA colonization, longer time from admission to PA isolation, diagnosis of urinary tract infection, and exposure to carbapenems were associated with the isolation of a R-C/T+CZA PA strain, while PA-related BSI, a comorbidity score > 7, and ICU stay were significantly associated with attributable mortality. C/T and CZA are important therapeutic resources for hard-to-treat PA-related infections, thus specific antimicrobial stewardship interventions should be prompted in order to avoid the development of this combined resistance, which would jeopardize the chance to treat these infections.

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