Microbiological and Antimicrobial Pattern of Diabetic Foot Ulcers at a Tertiary Care Center in East China

2021 ◽  
pp. 153473462110559
Author(s):  
Yaping Xie ◽  
Ying Xu ◽  
Kuang Chen ◽  
Can Chen ◽  
Jiao Huang ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Pathological State ◽  
E Coli ◽  
Diabetic Foot Infections ◽  
High Prevalence ◽  
Acinetobacter Spp ◽  
Gram Positive Cocci

Background Diabetic foot infections (DFIs) are the most complex and challenging pathological state, characterized by high complexity of management, morbidity, and mortality. Empirical antimicrobial administration is needed before the identification of the causative organisms. Microbiological profile of the diabetic foot patients is the basis of the antibiotic choice for clinicians. Methods 76 patients visiting the Diabetic Foot Center of our Hospital for having ulcers with Wagner 3 to 5 were retrospectively surveyed for the bacterium infected. Antimicrobial susceptibility testing (AST) was implemented and the results were interpreted on the basis of the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results A total of 92 isolates were obtained, of which 47 strains of gram-negative bacilli (GNB) accounted for 51.1%, 41 strains of gram-positive cocci (GPC) accounted for 44.6%, and 4 strains of fungi accounted for 4.3%. Species of Enterobacteriaceae and Staphylococcus are the two predominant strains. The top 4 most frequently isolated strains were Staphylococcus aureus (22.8%), enterococcus faecalis (9.8%), Pseudomonas aeruginosa (9.8%), Escherichia coli (5.4%). The rate of resistance to methicillin was 33.3% for S. aureus. The rate of extended-spectrum β-lactamases (ESBLs) production among E. coli was 60%. 50% of Klebsiella pneumoniae were resistant to carbapenems. P. aeruginosa showed high sensitivity to commonly used antibiotics. There was one isolate of Acinetobacter spp. resistant to most antimicrobials except tigecycline and aminoglycosides. Conclusion Enterobacteriaceae and Staphylococcus are the two predominant species. The resistance to antibiotics of S. aureus and P. aeruginosa showed optimistic results. However, the high prevalence of CRKP imposed a challenging issue for clinical physicians.

scholarly journals Laboratory Based Diagnosis of Bacteraemia among Inpatients and Outpatients with Acute Febrile Illness at Khwaja Yunus Ali Medical College and Hospital in Bangladesh

2020 ◽  
pp. 46-51 ◽  
Keyword(s):  
Antibiotic Susceptibility ◽  
Tertiary Care ◽  
Salmonella Typhi ◽  
Susceptibility Test ◽  
Gram Positive ◽  
Blood Samples ◽  
E Coli ◽  
Antibiotic Susceptibility Test ◽  
Acinetobacter Spp ◽  
Gram Positive Cocci

Bacteraemia is one of the important causes of mortality and morbidity worldwide. The emergence of multidrug-resistant bacterial strains is a major problem in its management. To encourage the prudent use of appropriate antibiotics in a tertiary care study was undertaken. A total of 282 patients with suspected bacteraemia from indoor and outdoor patients were included in this study. Blood samples were processed in the microbiology laboratory and bacteria were recognized by standard laboratory methods and then antibiotic susceptibility test was performed following CLSI guidelines. Out of a total of 282 blood samples, 55(19.50%) were culture positive. Among 55 positive cultures, Gram-positive Cocci and Gram-negative Bacilli were 48(87.3%) and 7(12.7%) respectively. The most predominant organisms were Staphylococcus aureus comprising 42(76.36%), followed by Salmonella typhi 4(7.30%), E. coli 2(3.63%) and Acinetobacter spp 1(1.81%). Among the isolated Staphylococcus spp, only 6(10.9%) isolates were Coagulase-Negative (CoNS). In antibiotic susceptibility test, all of the isolated bacterial pathogens were found susceptible to imipenem and meropenem (100%). For Salmonella typhi, all 4 isolated strains were found resistant to amoxicillin, amoxicillin+clavulanic acid (amoxyclave) and cephradine and 3 out of 4(75%) were susceptible to ciprofloxacin and levofloxacin. Most of the Gram-positive Cocci (GPC) were susceptible to levofloxacin (90%), ciprofloxacin (85%), and amikacin (83%). Both of E. coli and Acinetobacter spp were sensitive to amikacin (100%). This study stresses the need for continuous screening and surveillance for antibiotic resistance that would influence appropriate empiric treatment and infection control strategies for bacteremic cases.

scholarly journals Microbiologic Spectrum and Antibiotic Susceptibility Pattern among Patients with Urinary and Respiratory Tract Infection

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Maryam Sotoudeh Anvari ◽  
Mohammad Naderan ◽  
Mohammad Ali Boroumand ◽  
Saeed Shoar ◽  
Robab Bakhshi ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Wide Spectrum ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Cross Sectional ◽  
Disk Diffusion Test ◽  
Antibiotic Susceptibility Pattern ◽  
E Coli ◽  
Tract Infections

Aim. To demonstrate the prevalence of isolated organisms in urinary/respiratory tract infections and their antibiotic susceptibilities in a tertiary care center.Methods and Material. Between January 2008 and January 2010, patients referring to the clinic of cardiology or those admitted to the cardiac wards were enrolled in this cross-sectional descriptive study. Urine and sputum sampling was done for all the patients and the specimens underwent microbiologic examination and, in case of isolation of microorganism, antibiotic disk diffusion test was performed.Results. Escherichia coli (E. coli)was the most prevalent isolated organism in-hospital and community-acquired UTIs and was highly resistant to cephalothin in all the samples followed by cotrimoxazole, and ceftriaxone. It revealed high sensitivity to imipenem, amikacin, and nitrofurantoin.Acinetobacterconstituted the most prevalent organism isolated from respiratory secretions and represented the highest resistance to ceftriaxone and the greatest sensitivity to imipenem.Conclusions. E. coliandAcinetobacterremain the most common uropathogenic and respiratory organisms, respectively. However, their increasing resistance to wide-spectrum imipenem, meropenem, and vancomycin is a major concern.

scholarly journals Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study

2016 ◽  
Vol 10 (12) ◽  
pp. 1325-1331 ◽  
Author(s):  
Olivera Djuric ◽  
Snezana Jovanovic ◽  
Branka Stosovic ◽  
Tanja Tosic ◽  
Milica Jovanovic ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Aminoglycoside Resistance ◽  
Methicillin Resistant ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Clinically Relevant Bacteria

Introduction: We aimed to report the distribution and resistance patterns of eight invasive clinically relevant bacteria surveyed in the Clinical Center of Serbia (CCS) in Belgrade. Methodology: A total of 477 clinical blood stream isolates of Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. were collected in the period from January to December 2013. Antimicrobial susceptibility testing was performed using standard methods and interpreted using the Clinical and Laboratory Standards Institute (CLSI) breakpoint criteria. Results: Acinetobacter spp. was the most prevalent bacteria encountered (37%), followed by K. pneumoniae (25.7%). Multidrug resistance was observed in 92.5% of all isolates. Out of 177 strains of Acinetobacter spp., 97.7% were resistant to fluoroquinolones and carbapenems. Resistance to aminoglycosides, fluoroquinolones, and third-generation cephalosporins was 97.1%, 95.4%, and 95.8% among K. pneumoniae and 21.4%, 21.7%, and 31% among E. coli isolates, respectively. In total, 65.1% of K. pneumoniae and 12.1% of E. coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) positive. High-level aminoglycoside resistance of E. faecalis was 71.4%, and glycopeptide resistance of E. faecium was 95%. Out of 66 strains of S. aureus, 63.4% were methicillin resistant. Conclusions: The majority of bloodstream isolates of clinically relevant bacteria in CCS were multidrug resistant. The biggest concerns are carbapenem-resistant Acinetobacter spp., K. pneumoniae, and P. aeruginosa; third-generation cephalosporin-resistant E. coli; vancomycin-resistant E. faecium; and methicillin-resistant S. aureus. Stricter measures of infection control and antibiotic use are needed.

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North West, Pakistan

2021 ◽  
pp. 1-13
Author(s):  
Muhammad Arshad Siddiqui ◽  
Hamza Naeem ◽  
Muhammad Mohsin Ali ◽  
Fawad Ahmad Randhawa ◽  
Shahida Nazir ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Tertiary Care Center ◽  
Continuous Variables ◽  
Tissue Samples ◽  
North West ◽  
Antimicrobial Sensitivity ◽  
Diabetic Foot Infections

Abstract Objective: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections presenting at a tertiary care center in North West, Pakistan. Methods: 201 patients were included in the study, which was conducted over a period of 08 months from January 2019 to August 2019, at the Diabetes & Footcare Clinic (DFC), Mayo Hospital Lahore. Deep-seated tissue samples (0.5 x 0.5 cm) were taken from ulcer bed and immediately sent for culture & sensitivity (C&S) testing. Antimicrobial susceptibility was determined in accordance with Clinical & Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using SPSS version 26.0. Data was presented as Mean ± SD for continuous variables & frequency with percentage for categorical variables. Results: Mean age of participants was 53.05 ± 10.70, from which 66.7 % (134) were male. Grade 3 DFUs (51.7%) and grade 2 DFIs were most prevalent (62.7%). Out of 201 tissue specimens, 389 bacterial isolates were collected. Monomicrobial specimens accounted for 28.4%, with the rest (71.6%) being polymicrobial. Gram negative organisms were 238 (61.11%) while the rest (38.89%) were gram positive organisms. There was a high incidence of methicillin resistant S. aureus (MRSA) at 64.58%. Highest susceptibility of S. aureus was reported with vancomycin and fusidic acid at 100% and 79.35%. Continuous...

scholarly journals Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care center in North-eastern Tanzania

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Andrew Mganga ◽  
Jeff Van Baal ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Random Blood Glucose ◽  
North Eastern ◽  
The Mean

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.

scholarly journals Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

2019 ◽  
Vol 38 (1) ◽  
pp. 12-17
Author(s):  
Farah Nobi ◽  
Syed Al Nahian ◽  
Afrin Sultana ◽  
Rokhsana Sarmin ◽  
Ayesha Rahman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Peripheral Vascular ◽  
Tertiary Care Centre ◽  
Term Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

Usefulness of some current balance tests for identifying individuals with disequilibrium due to vestibular impairments

2009 ◽  
Vol 18 (5-6) ◽  
pp. 295-303
Author(s):  
Helen S. Cohen ◽  
Kay T. Kimball
Keyword(s):  
Sensitivity And Specificity ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Vestibular Disorders ◽  
Timed Up And Go ◽  
Balance Tests ◽  
Walking Balance

The goal of this study was to determine which of several clinical balance tests best identifies patients with vestibular disorders. We compared the scores of normals and patients on the Berg Balance Scale (Berg), Dynamic Gait Index (DGI), Timed Up and Go (TUG), Computerized Dynamic Posturography Sensory Organization Test (SOT), and a new obstacle avoidance test: the Functional Mobility Test (FMT). The study was performed in an out-patient balance laboratory at a tertiary care center. Subjects were 40 normal adults, and 40 adults with vestibular impairments. The main outcome measures were the sensitivity of tests to patients and specificity to normals. When adjusted for age the Berg, TUG, DGI and FMT had moderate sensitivity and specificity. SOT had moderately high sensitivity and specificity. SOT and FMT, combined, had high sensitivity and moderate specificity. Therefore, the kinds of tests of standing and walking balance that clinicians may use to screen patients for falling are not as good for screening for vestibular disorders as SOT. SOT combined with FMT is better. When screening patients for vestibular disorders, when objective diagnostic tests of the vestibular system, itself, are unavailable, tests of both standing and walking balance, together, give the most information about community-dwelling patients. These tests may also indicate the presence of sub-clinical balance problems in community-dwelling, asymptomatic adults.

scholarly journals A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-encoding genes

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sulochana Manandhar ◽  
Raphael M. Zellweger ◽  
Nhukesh Maharjan ◽  
Sabina Dongol ◽  
Krishna G. Prajapati ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Tertiary Care ◽  
Multi Drug Resistance ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Global Public Health ◽  
Gram Negative ◽  
E Coli ◽  
Extended Spectrum ◽  
High Prevalence

Abstract Background Multi-drug resistance (MDR) and extensive-drug resistance (XDR) associated with extended-spectrum beta-lactamases (ESBLs) and carbapenemases in Gram-negative bacteria are global public health concerns. Data on circulating antimicrobial resistance (AMR) genes in Gram-negative bacteria and their correlation with MDR and ESBL phenotypes from Nepal is scarce. Methods A retrospective study was performed investigating the distribution of ESBL and carbapenemase genes and their potential association with ESBL and MDR phenotypes in E. coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. isolated in a major tertiary hospital in Kathmandu, Nepal, between 2012 and 2018. Results During this period, the hospital isolated 719 E. coli, 532 Klebsiella spp., 520 Enterobacter spp. and 382 Acinetobacter spp.; 1955/2153 (90.1%) of isolates were MDR and half (1080/2153) were ESBL producers. Upon PCR amplification, blaTEM (1281/1771; 72%), blaCTXM-1 (930/1771; 53%) and blaCTXM-8 (419/1771; 24%) were the most prevalent ESBL genes in the enteric bacilli. BlaOXA and blaOXA-51 were the most common blaOXA family genes in the enteric bacilli (918/1771; 25%) and Acinetobacter spp. (218/382; 57%) respectively. Sixteen percent (342/2153) of all isolates and 20% (357/1771) of enteric bacilli harboured blaNDM-1 and blaKPC carbapenemase genes respectively. Of enteric bacilli, Enterobacter spp. was the most frequently positive for blaKPC gene (201/337; 60%). The presence of each blaCTX-M and blaOXA were significantly associated with non-susceptibility to third generation cephalosporins (OR 14.7, p < 0.001 and OR 2.3, p < 0.05, respectively).The presence of each blaTEM, blaCTXM and blaOXA family genes were significantly associated with ESBL positivity (OR 2.96, p < 0.001; OR 14.2, p < 0.001 and OR 1.3, p < 0.05 respectively) and being MDR (OR 1.96, p < 0.001; OR 5.9, p < 0.001 and OR 2.3, p < 0.001 respectively). Conclusions This study documents an alarming level of AMR with high prevalence of MDR ESBL- and carbapenemase-positive ESKAPE microorganisms in our clinical setting. These data suggest a scenario where the clinical management of infected patients is increasingly difficult and requires the use of last-resort antimicrobials, which in turn is likely to intensify the magnitude of global AMR crisis.

Sign in / Sign up

Export Citation Format

Share Document