Moderate to Severe Soft Tissue Diabetic Foot Infections

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

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Are surrogate markers for diabetic foot osteomyelitis remission reliable?

Journal of the American Podiatric Medical Association ◽

10.7547/20-147 ◽

2020 ◽

Author(s):

Peter A Crisologo ◽

Matthew Malone ◽

Javier La Fontaine ◽

Orhan Oz ◽

Kavita Bhavan ◽

...

Keyword(s):

Soft Tissue ◽

Diabetic Foot ◽

Bone Biopsy ◽

Surrogate Marker ◽

Surrogate Markers ◽

Bone Culture ◽

Soft Tissue Infections ◽

Diabetic Foot Infections ◽

Index Site ◽

Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

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

10.21203/rs.2.15844/v2 ◽

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)

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Microbial Profile and Utility of Soft Tissue, Pus, and Bone Cultures in Diagnosing Diabetic Foot Infections

Diabetes Technology & Therapeutics ◽

10.1089/dia.2012.0039 ◽

2012 ◽

Vol 14 (8) ◽

pp. 669-674 ◽

Cited By ~ 16

Author(s):

Nadeem Parvez ◽

Pinaki Dutta ◽

Pallab Ray ◽

Viral N. Shah ◽

Mahesh Prakash ◽

...

Keyword(s):

Soft Tissue ◽

Diabetic Foot ◽

Microbial Profile ◽

Diabetic Foot Infections ◽

Bone Cultures

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Antibodies to Staphylococcus aureus Bone Sialoprotein-Binding Protein Indicate Infectious Osteomyelitis

Clinical and Vaccine Immunology ◽

10.1128/cvi.00442-08 ◽

2009 ◽

Vol 16 (6) ◽

pp. 949-952 ◽

Cited By ~ 10

Author(s):

Lena Persson ◽

Christian Johansson ◽

Cecilia Rydén

Keyword(s):

Staphylococcus Aureus ◽

Soft Tissue ◽

Diabetic Foot ◽

Matrix Protein ◽

Binding Protein ◽

Bone Matrix ◽

Clinical Problem ◽

Bone Sialoprotein ◽

Diabetic Foot Infections ◽

Bone Matrix Protein

ABSTRACT Discrimination of soft tissue infection from osteomyelitis in diabetic foot infections is a common clinical problem. Staphylococcus aureus isolates from patients with osteomyelitis express bone sialoprotein-binding protein (Bbp) that binds the bone matrix protein bone sialoprotein. The serological assay with Bbp discriminated cases of osteomyelitis from soft tissue infections in patients with diabetic foot ulcers.

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Pharmacokinetics and penetration of linezolid into inflamed soft tissue in diabetic foot infections

European Journal of Clinical Pharmacology ◽

10.1007/s00228-008-0531-5 ◽

2008 ◽

Vol 64 (11) ◽

pp. 1093-1100 ◽

Cited By ~ 31

Author(s):

J. Majcher-Peszynska ◽

G. Haase ◽

M. Saß ◽

R. Mundkowski ◽

A. Pietsch ◽

...

Keyword(s):

Soft Tissue ◽

Diabetic Foot ◽

Diabetic Foot Infections

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Development of a Novel Collagen Wound Model To Simulate the Activity and Distribution of Antimicrobials in Soft Tissue during Diabetic Foot Infection

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01064-16 ◽

2016 ◽

Vol 60 (11) ◽

pp. 6880-6889 ◽

Cited By ~ 16

Author(s):

Bianca L. Price ◽

Andrew M. Lovering ◽

Frank L. Bowling ◽

Curtis B. Dobson

Keyword(s):

Soft Tissue ◽

Diabetic Foot ◽

Calcium Sulfate ◽

Collagen Matrix ◽

Multidrug Resistant ◽

Biofilm Growth ◽

Content Type ◽

Wound Fluid ◽

Diabetic Foot Infections ◽

Wound Model

ABSTRACTDiabetes has major implications for public health, with diabetic foot ulcers (DFUs) being responsible for significant morbidity and mortality. A key factor in the development of nonhealing ulcers is infection, which often leads to the development of biofilm, gangrene, and amputation. A novel approach to treating DFUs is the local release of antibiotics from calcium sulfate beads. We have developed a novel model system to study and compare the release and efficacy of antibiotics released locally, using collagen as a substrate for biofilm growth and incorporating serum to mimic the biochemical complexity of the wound environment. We found that our soft-tissue model supports the growth of a robustPseudomonas aeruginosabiofilm, and that this was completely eradicated by the introduction of calcium sulfate beads loaded with tobramycin or gentamicin. The model also enabled us to measure the concentration of these antibiotics at different distances from the beads and in simulated wound fluid bathing the collagen matrix. We additionally found that a multidrug-resistantStaphylococcus aureusbiofilm, nonsusceptible to antibiotics, nonetheless showed an almost 1-log drop in viable counts when exposed to calcium sulfate beads combined with antibiotics. Together, these data suggest that locally applied antibiotics combined with calcium sulfate provide surprising efficacy in diabetic foot infections and offer an effective alternative approach to infection management. Our study additionally establishes our new system as a biochemically and histologically relevant model that may be used to study the effectiveness of a range of therapies locally or systemically for infected DFUs.

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