Bacterial Diversity, Antibiotic Resistance, and the Risk of Lower Limb Amputation in Younger and Older Individuals With Diabetic Foot Infection

2021 ◽  
pp. 153473462199229
Author(s):  
Stefan Dörr ◽  
Ann-Kathrin Holland-Letz ◽  
Gregor Weisser ◽  
Apostolos Chatzitomaris ◽  
Ralf Lobmann
Keyword(s):  
Bacterial Diversity ◽  
Diabetic Foot ◽  
Care Center ◽  
Bacterial Load ◽  
Limb Amputation ◽  
Older Individuals ◽  
Foot Care ◽  
Gram Positive ◽  
Gram Negative ◽  
Diabetic Foot Infection

Introduction A diabetic foot infection (DFI) contributes to high mortality and morbidity in diabetics due to its often rapid progressive and intricately treatable infection. DFIs are usually a polymicrobial infection and characterizing the entire bacterial load is still challenging. Prompt and effective treatment of DFI is nevertheless mandatory to safe limbs and lives. It is therefore crucial to know the local pathogen spectrum and its antibiotic susceptibility. Methods and Material For a 12-month period, we investigated 353 individuals with infected diabetic foot ulcer, their bacterial diversity, and antimicrobial susceptibility at fist-time visit in a Diabetic Foot Care Center in southern Germany. Results Cultures yielded 888 species, most of them gram-positive cocci (primary Staphylococcus aureus). The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriacae. Because the prevalence of multiresistant species was surprisingly low (0.9% of isolated strains), we suggest penicillins with β-lactamase inhibitor in case of gram-positive–dominated infection or piperacillin/tazobactam or rather carbapenems with equal efficacy when gram-negative species are involved.

scholarly journals Parallels of infections of diabetic foot syndrome at inpatient and outpatient stages of treatment

2021 ◽  
pp. 68-76
Author(s):  
A. B. Zemlianoi ◽  
T. A. Zelenina ◽  
V. V. Salukhov
Keyword(s):  
Diabetic Foot ◽  
Acute Infection ◽  
Multidrug Resistant ◽  
Diabetic Foot Syndrome ◽  
Gram Positive ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Infectious Process ◽  
Group 2 ◽  
Group 1

Introduction. Long-lasting ulcerative defects in patients with diabetic foot syndrome (DFS) are prone to reinfection, persistence of primary and hospital-acquired infection, and the infectious process is often caused by multidrug-resistant organisms (MDRO).Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.Materials and methods. We included 62 type 2 diabetic inpatients (group 1) with severe foot infection and 102 diabetic foot outpatients (group 2) with postoperative wounds, who had been operated on and discharged from the hospital, in to the study.Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.Results and discussion. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.Conclusion. The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gramnegative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment. The role of Enterobacterales increased with duration of infection. The prevalence of multidrug resistant Enterobacterales makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.

scholarly journals Microbiological and clinical characteristics of diabetic foot infections in northern India

2012 ◽  
Vol 6 (04) ◽  
pp. 329-332 ◽  
Author(s):  
Shalbha Tiwari ◽  
Daliparthy D Pratyush ◽  
Awanindra Dwivedi ◽  
Sanjiv K Gupta ◽  
Madhukar Rai ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Clinical Evidence ◽  
Gram Positive ◽  
Bacteriological Study ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
Microbial Infections ◽  
Leukocyte Counts

Introduction:  India has the largest diabetic population of 50.8 million that could reach an epidemic proportion by 2030. Diabetic foot infection is one of the dreaded complications of diabetes.  Only a few studies that focus on patterns of diabetic foot infection in our region, where diabetic foot care is inadequate, are available. This study evaluated microbial and clinical characteristics of diabetic foot infections that will be helpful in taking appropriate measures for their management. Methodology: In this prospective study conducted during 2008-2009, sixty-two diabetic foot patients underwent detailed history, clinical examination, and laboratory investigations including parameters of systemic infections. Microbial culture and sensitivity were performed at the time of presentation. Results: Among 62 cases, 43.5% had mono-microbial infection, 35.5% had poly-microbial infections, and 21% had sterile culture. Among 82 bacteria isolated, 68% were Gram negative and 32% were Gram positive. Leukocyte counts were higher (16928±9642 versus 14593±6687 cells/mm3) and haemoglobin (7.9±2.4 versus 9.2±2.2 mg/dl) lower in poly-microbial compared to mono-microbial infections. Haemoglobin counts were lower and leukocyte counts higher in Gram-negative compared to Gram-positive infections. Patients with sterile cultures also had clinical evidence of persistent infection. Escherichia coli were the most common isolate and piperacillin/tazobactam showed highest sensitivity. Conclusions: Gram-negative bacteria were most prevalent in diabetic foot infection. It is not uncommon to have culture reports negative despite clinical evidence of infection. This study suggests that piperacillin/tazobactam should be the treatment of choice on an empirical basis prior to a definitive bacteriological study and in cases with negative culture reports.

scholarly journals Bacteriological Profile and Antibiotic Susceptibility Pattern of Diabetic Foot Infection in a Tertiary Care Hospital in Lampung, Indonesia

2021 ◽  
Vol 28 (5) ◽  
pp. 42-53
Author(s):  
Iswandi Darwis ◽  
◽  
Hidayat Hidayat ◽  
Gusti Ngurah P Pradnya Wisnu ◽  
Sekar Mentari ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Medical Records ◽  
Antibiotic Susceptibility ◽  
Gram Negative Bacteria ◽  
High Susceptibility ◽  
Gram Positive ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Gram Positive Bacteria ◽  
Wound Culture

Background: Diabetic foot infection (DFI) is a serious complication of diabetes mellitus and identification of the causative bacteria is an essential step in selecting the appropriate antibiotic therapy. This study aimed to evaluate the bacterial pattern and antibiotic susceptibility of the bacteria causing DFI in Lampung Province in Indonesia. Methods: This study is a retrospective study reviewing the medical records of DFI patients admitted to the Dr Hi Abdul Moeloek Regional General Hospital in 2017–2019. DFI patients with complete medical record data were included in this study. Demographic, clinical, laboratory, wound culture and antibiotic susceptibility data were collected from the medical records using a short structural chart. The data obtained then reviewed. Results: In this study, 131 DFI patients met the study criteria and were included. Based on the wound culture results, Gram-negative bacteria were obtained in 112 (85.5%) subjects with Enterobacter spp. as the predominant bacteria. Gram-positive bacteria were found in 19 (14.5%) subjects with Staphylococcus spp. as the predominant bacteria. Gram-negative bacteria found in this study showed high susceptibility to amikacin, meropenem and sulbactam/cefoperazone. Meanwhile, the Gram-positive bacteria showed high susceptibility to meropenem, sulbactam/ cefoperazone and amikacin. Conclusion: The findings of the study revealed Enterobacter spp. as the most predominant bacteria causing DFI in the studied population. The highest antibiotic susceptibility was seen for amikacin, meropenem and sulbactam/cefoperazone.

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 How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Heather Young ◽  
Whitney Miller ◽  
Randy Burnham ◽  
Susan Heard ◽  
Chrystal Berg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Negative Results ◽  
Diabetic Foot Infections ◽  
Preoperative Antibiotics ◽  
The Impact ◽  
Culture Negative ◽  
Culture Yield

abstractThe impact of preoperative antibiotics on culture of diabetic foot infection samples has not been studied. We found that increasing exposure to preoperative antibiotics was associated with less frequent growth of streptococci and anaerobes and more culture-negative results. In contrast, the yield of Staphylococcus aureus and Gram-negative bacilli was unaffected.

scholarly journals A CLINICAL STUDY ON AMPUTATIONS IN GENERAL SURGERY

2020 ◽  
pp. 1-2
Author(s):  
K. Vijay Babu ◽  
Darga Mahammad Mehatab Hussain
Keyword(s):  
Clinical Study ◽  
Surgical Procedures ◽  
General Surgery ◽  
Diabetic Foot ◽  
Congenital Anomalies ◽  
Limb Amputation ◽  
Peripheral Vascular ◽  
Diabetic Foot Infection ◽  
First Case ◽  
In The Beginning

Amputations is the Post graduates first case in the beginning and is one of the most ancient of all surgical procedures done for several indications, including trauma, peripheral vascular disease, tumor, diabetic foot infection and congenital anomalies.1,2,3 Some times limb amputation is considered the last resort when limb salvage is impossible or when the limb is dead or dying, viable but non- functional or endangering the patient's life.4

scholarly journals Awareness of Diabetic Foot and its Risk Factors in the General Population of Arar, Northern Saudi Arabia

2021 ◽  
pp. 205-213
Author(s):  
Abdelrahman Mohamed Ahmed Abukanna ◽  
Ghaida Abdullah R. Alshamlani ◽  
Alenezi,Ahlam Sultan F. ◽  
Reham Arif A. Alanazi ◽  
Shahad Fahis A. Alanazi
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Saudi Arabia ◽  
Primary Health Care ◽  
General Population ◽  
Diabetic Foot ◽  
Care Center ◽  
Limb Amputation ◽  
Health Care Center ◽  
Primary Health

Background: Foot ulcers may be complicated to toe amputation or limb amputation which can be prevented by patient education on self-management and appropriate foot care procedures. Study Objectives: The objective of this study is to determine the awareness of diabetic foot and its risk factors among the general population of Arar city, Northern Saudi Arabia. Methods: An analytical cross-sectional study was carried out in primary health care centers in Arar, Northern Saudi Arabia, during the period from 1st September to 10th October 2021. Data was collected by personal interview with the attendees of the primary health care center, using a predesigned questionnaire. Results: Almost 60% of participants have knowledge about diabetic foot. The Source of information about diabetic foot was doctors and nurses in 13% and 11.9% social media in our study population. 62.7% know that diabetic foot risk may be reduced by controlling blood sugar level, 13% by checking the feet every day and several times a day, and 9.2% reported wearing shoes and socks on a daily basis. 65.6%, 66.7%, 48.4%, 82.6% and 62.1% knew that skin infections, foot abscess, bone infections, gangrene, and foot deformity are complications of diabetic foot respectively. Good knowledge of diabetic foot was significantly associated with age and educational level but not with marital status. Conclusion: The level of knowledge of diabetic foot and its related complications is relatively average. Due to the high incidence of diabetes mellitus (DM) in Saudi Arabia, it is vital that the population has appropriate information and awareness about this illness to enable continued promotion of public health measures to limit its prevalence. It is also crucial for DM patients to understand the medication and lifestyle modifications that may enable them to better regulate their blood glucose and prevent the complications.

scholarly journals Bacteriology in Diabetic Foot Infections: A Multicentre Crosssectional Study in Malaysia and Comparison with Southeast Asia Countries

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Kow Ren Yi
Keyword(s):  
Southeast Asia ◽  
Diabetic Foot ◽  
Communicable Disease ◽  
Southeast Asian ◽  
Asian Countries ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Comparison Results ◽  
District Hospitals ◽  
Southeast Asian Countries

Introduction: Diabetes mellitus is a major non-communicable disease in Malaysia and Southeast Asian Countries. In this study, we aimed to determine the microbiological profile of diabetic foot infection and the antibiotic susceptibility in Malaysia and to compare our findings with that from other Southeast Asia countries. Materials and Methods: A cross-sectional study was conducted in three district hospitals (Bentong, Raub and Kuala Lipis) from the 1 st January to the 31st December 2016. Microbiological profiles of intra-operative deep tissue and bone samples from diabetic foot infection were included. Studies reporting the microbiological profiles from Southeast Asia countries were reviewed and the data were extracted for comparison. Results: A high incidence of gram negative pathogens was isolated (73.4%). The predominant pathogens isolated included Staphylococcus sp (17.5%), Klebsiella sp (17%), Pseudomonas sp (15.4%) and Proteus sp (13.8%). Among those gram negative pathogens tested, a high number of them were resistant to ampicillin and amoxicillin/clavulanic acid. They were sensitive to imipenem (98.9%), tazosin (97.7%) and ampicillin-sulbactam (84.8%). All Southeast Asian countries studied except Singapore have high gram negative to gram positive pathogens ratio. Conclusion: The empirical antibiotics should be tailored to the local bacteriological profiles of diabetic foot infection.

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