Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx016 ◽

2017 ◽

Vol 4 (1) ◽

Cited By ~ 2

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.

Download Full-text

Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2967 ◽

2013 ◽

Vol 7 (10) ◽

pp. 707-712 ◽

Cited By ~ 27

Author(s):

Vedat Turhan ◽

Mesut Mutluoglu ◽

Ali Acar ◽

Mustafa Hatipoglu ◽

Yalcın Onem ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Geographical Location ◽

Antibiotic Sensitivity ◽

Diabetic Patients ◽

Tissue Samples ◽

Gram Negative ◽

Diabetic Foot Infections ◽

Pseudomonas Species ◽

Gram Negative Organisms

Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles. Methodology: We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010. Results: We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial. Gram-negative bacterial isolates (n = 191; 61.3%) significantly outnumbered Gram-positive isolates (n = 121; 38.7%). The most frequently isolated bacteria were Pseudomonas species (29.8%), Staphylococcus aureus (16.7%), Enterococcus species (11.5%), Escherichia coli (7.1%), and Enterobacter species (7.1%), respectively. While 13.2% of the Gram-negative isolates were inducible beta-lactamase positive, 44.2% of Staphylococcus aureus isolates were methicillin resistant. Conclusions: Our results support the recent view that Gram-negative organisms, depending on the geographical location, may predominate in DFIs.

Download Full-text

A clinical study of commonly isolated organism and its antibiotic sensitivity in diabetic foot ulcers in Sri Manakula Vinayagar Medical College and Hospital, Pondicherry

International Surgery Journal ◽

10.18203/2349-2902.isj20203032 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2512

Author(s):

Anand Shanmugaiah ◽

Saravanan Pandian ◽

Sudha Selvam

Keyword(s):

Staphylococcus Aureus ◽

Blood Sugar ◽

Diabetic Foot ◽

Foot Ulcer ◽

Antibiotic Sensitivity ◽

Diabetic Foot Ulcer ◽

Empirical Therapy ◽

Gram Negative ◽

Medical College ◽

Diabetic Foot Infections

Background: Diabetic foot ulcer is one of the major surgical problem leading to hospital admission. Diabetic foot ulcer patients with uncontrolled diabetes may end up in forefoot amputation. Early aggressive debridement, control of blood sugar and empirical antibiotic therapy would reduce the morbidities in patients with diabetic foot ulcer. Further the knowledge of commonly isolated microbes and their antibiotic sensitivity pattern would be helpful to start empirical therapy. The purpose of this study was to determine the microbiological proﬁle of diabetic foot infections (DFIs) and assess the antibiotic susceptibility of the causative agents.Methods: This cross-sectional study was conducted in 115 patients admitted with diabetic foot ulcer over a period of 9 months from October 2015 to June 2016 at the department of general surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. Tissue scrapping samples were collected and processed as per standard guidelines.Results: 167 organisms were isolated from 115 patients. 52% of culture showed polymicrobial growth. There was increased prevalence of gram-negative organisms 53% compared to gram positive organisms 47%. When comes to individual isolate, Staphylococcus aureus was the most common organism isolated 24.6% followed by Pseudomonas aeruginosa 21%. All gram-positive aerobes were sensitive to vancomycin and gram-negative isolates were sensitive to amikacin, piperacillin-tazobactum, gentamycin and cefotaxime.Conclusions: Staphylococcus aureus and Pseudomonas were the common pathogens isolated. This study recommends use of vancomycin along with piperacillin-tazobactum as an empirical therapy along with adequate blood sugar control and early debridement of devitalized tissues in patients with diabetic foot infections.

Download Full-text

Correlation between Antibiotic Resistance of Main Gram-Negative Pathogens and Antibiotic Consumption in a General Hospital of China

10.21203/rs.2.14342/v1 ◽

2019 ◽

Author(s):

Shaoqing Shen ◽

Rui Wang ◽

Jin Wang ◽

Yun Cai

Keyword(s):

Antibiotic Resistance ◽

Bacterial Resistance ◽

Mainland China ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Multidrug Resistant ◽

Resistance Rate ◽

Gram Negative ◽

Positive Effects ◽

Resistance Rates

Abstract Purpose Our hospital is a newly established hospital in China, which is located in the tropics. Better depicting antibiotic consumption and antibiotic resistance may help better develop and implement an antibiotic stewardship with regional characteristics.Methods Total antibiotic prescriptions, patient days and microbiological data from January 2014 to December 2017 were collected. Antibiotic use density (AUD) was expressed as daily defined dose (DDD) and normalized per 100 patient-days. The resistance rates of Gram-negative pathogens against commonly used antibiotics were calculated. The relationship between antibiotic consumption and bacterial resistance rate was described by Pearson’s correlation coefficient.Results Different from mainland China, A. baumannii was the leading Gram-negative pathogen, followed by K. pneumoniae , E. coli and P. aeruginosa . The AUD was gradually increased from 2014 to 2016, while it was slowly decreased in 2017. Ceftazidime/tazobactam, levofloxacin and meropenem were the top three consumed antibiotics. The proportion of multidrug resistant (MDR) Gram-negative bacteria was increased (>40%) before 2016, and it was decreased in 2017. The prevalence of MDR A. baumannii and MDR P. aeruginosa was correlated with the AUD of β-lactam/lactamase inhibitors, fluoroquinolones and carbapenems. The increased AUD of meropenem had positive effects on the incidence of carbapenem-resistant A. baumannii and P. aeruginosa .Conclusions Our study showed that there was an association between the resistance density of Gram-negative pathogens and the consumption of β-lactam/lactamase inhibitors, carbapenems and fluoroquinolones. Collectively, a multifaceted antimicrobial stewardship is necessary to decrease resistance density of available antibiotics.

Download Full-text

Spectral and Antibiotic Susceptibility of Pathogens Isolated from Saudi Patients with Diabetic Foot Infections

Microbiology Research ◽

10.3390/microbiolres12010002 ◽

2021 ◽

Vol 12 (1) ◽

pp. 16-20

Author(s):

Samiah Hamad S Al-Mijalli

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Antibiotic Susceptibility ◽

Empirical Therapy ◽

Multidrug Resistant ◽

Foot Ulcers ◽

Sensitivity Testing ◽

Cross Sectional ◽

Diabetic Foot Infections ◽

Microbiological Methods

Diabetic foot infections (DFIs) are a significant health issue and a common complication among patients with diabetes. To develop antibiotic therapy for these high-risk patients, the current study evaluates the scope of DFIs and identifies the causing microbes. It also measures spectrum and antibiotic susceptibility of the pathogens isolated from adults with DFIs in Saudi Arabia. To achieve the study objectives, a cross-sectional study was implemented and the baseline characteristics for 44 patients with DFIs were defined. Optimal aerobic and anaerobic microbiological techniques were utilized to culture specimens isolated from infected foot ulcers. The standard microbiological methods were employed to identify the bacterial isolates and antibiotic susceptibility testing was conducted following the procedures of the Clinical and Laboratory Standards Institute (CLSI). Results showed that 12 microorganisms were isolated from the participants’ diabetic foot ulcers. Staphylococcus Aureus was ranked first because it appeared in 29 (65.9%) cases. Streptococcus Agalactiae was ranked second and multi-microbial infections were also found. Most of the organisms were susceptible to Vancomycin, Ciprofloxacin, and Cefalexin, but they were resistant to Methicillin, Gentamicin, and Ampicillin antibiotics. Staphylococcus Aureus was most sensitive to Ciprofloxacin, while it was resistant to Methicillin. About 10% of the isolates were multidrug-resistant. The study concludes that while Vancomycin should be used empirically for Gram-positive isolates, Ciprofloxacin can be taken into consideration for most of the Gram-negatives aerobes. Based on including various microorganisms and the advent of multidrug-resistant strains, proper culture and sensitivity testing are necessary prior to the empirical therapy.

Download Full-text

Methicillin-resistant Staphylococcus aureus of the clonal lineage ST5-SCCmecII-t2460 was associated with high mortality in a Wuhan hospital

Brazilian Journal of Microbiology ◽

10.1007/s42770-021-00557-5 ◽

2021 ◽

Author(s):

Xuehan Li ◽

Jing Zhang ◽

Yifan Zhang ◽

Junying Zhou ◽

Xinwei Li ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Resistance ◽

White Blood Cells ◽

Resistance Rate ◽

Molecular Characteristics ◽

Invasive Procedures ◽

Methicillin Resistant ◽

Small Colony Variant ◽

Recent Emergence ◽

Resistance Rates

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen that can cause serious infectious diseases. An emerging MRSA strain, ST5-SCCmecII spa-type-t2460 (SMRSA), has spread rapidly since its recent emergence in China, but little information is available about this lineage. In this study, 91 MRSA isolates were collected from patients treated in the Zhongnan Hospital, Wuhan University, from 2018 to 2019, and investigated for their molecular characteristics, antibiotic resistance profiles, and clinical characteristics. The predominant lineage, SMRSA, accounted for 37.4% (34/91) of the isolates, followed by ST239-SCCmecIII-t030 (19.8%, 18/91) and ST59-SCCmecIV-t437 (8.8%, 8/91). In contrast to the latter two non-SMRSA (nSMRSA) lineages, which are among the main MRSA found in Chinese settings, SMRSA exhibited small colony variant (SCV) phenotype and had extremely high resistance rates to erythromycin (100.0%), clindamycin (100.0%), levofloxacin (100.0%), tetracycline (97.1%), moxifloxacin (97.1%), and ciprofloxacin (100%), but was more susceptible to rifampicin (resistance rate 3%). The levels of white blood cells (WBC) and procalcitonin (PCT) and the 30-day mortality in patients infected with SMRSA were (12.54 ± 6.61) × 109/L, 0.66 ng/mL, and 52.9%, respectively, which were much higher than those in patients infected with nSMRSA. In addition, patients infected with SMRSA were more frequently admitted to the intensive care unit (ICU) and submitted to invasive procedures than those infected with nSMRSA. In conclusion, SMRSA showed SCV phenotype and exhibited multiple antibiotic-resistance profiles. In this study, SMRSA was associated with serious infections and poor prognosis. Compared with ST239, ST59, or other nSMRSA strains, patients infected with SMRSA strains have higher 30-day mortality, increased levels of inflammatory biomarkers, and more frequent ICU hospitalization and invasive procedures.

Download Full-text

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa412 ◽

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.

Download Full-text

Comparison of Methicillin-Resistant Staphylococcus aureus Isolates from Cellulitis and from Osteomyelitis in a Taiwan Hospital, 2016–2018

Journal of Clinical Medicine ◽

10.3390/jcm8060816 ◽

2019 ◽

Vol 8 (6) ◽

pp. 816 ◽

Cited By ~ 1

Author(s):

Kuo-Ti Peng ◽

Tsung-Yu Huang ◽

Yao-Chang Chiang ◽

Yu-Yi Hsu ◽

Fang-Yi Chuang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Resistance ◽

Methicillin Resistant Staphylococcus Aureus ◽

Joint Infection ◽

Sccmec Type ◽

Multidrug Resistant ◽

Chang Gung Memorial Hospital ◽

Methicillin Resistant ◽

Mrsa Strains ◽

Resistance Rates

Methicillin-resistant Staphylococcus aureus (MRSA) causes superficial infections such as cellulitis or invasive infections such as osteomyelitis; however, differences in MRSA isolates from cellulitis (CL-MRSA) and from osteomyelitis (OM-MRSA) at the same local area remain largely unknown. A total of 221 MRSA isolates including 106 CL-MRSA strains and 115 OM-MRSA strains were collected at Chang-Gung Memorial Hospital in Taiwan between 2016 and 2018, and their genotypic and phenotypic characteristics were compared. We found that OM-MRSA isolates significantly exhibited higher rates of resistance to multiple antibiotics than CL-MRSA isolates. Genotypically, OM-MRSA isolates had higher proportions of the SCCmec type III, the sequence type ST239, and the spa type t037 than CL-MRSA isolates. Besides the multidrug-resistant lineage ST239-t037-SCCmecIII more prevalent in OM-MRSA, higher antibiotic resistance rates were also observed in several other prevalent lineages in OM-MRSA as compared to the same lineages in CL-MRSA. Furthermore, when prosthetic joint infection (PJI) associated and non-PJI-associated MRSA strains in osteomyelitis were compared, no significant differences were observed in antibiotic resistance rates between the two groups, albeit more diverse genotypes were found in non-PJI-associated MRSA. Our findings therefore suggest that deep infections may allow MRSA to evade antibiotic attack and facilitate the convergent evolution and selection of multidrug-resistant lineages.

Download Full-text

Daptomycin for Methicillin-Resistant Staphylococcus aureus Diabetic Foot Infections

Journal of the American Podiatric Medical Association ◽

10.7547/0003-0538-104.2.159 ◽

2014 ◽

Vol 104 (2) ◽

pp. 159-168 ◽

Cited By ~ 3

Author(s):

Warren S. Joseph ◽

Thomas Quast ◽

Alberto Cogo ◽

Monica G. Crompton ◽

Min Jung Yoon ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Methicillin Resistant Staphylococcus Aureus ◽

Clinical Success ◽

Initial Therapy ◽

Antibiotic Agent ◽

Negative Effects ◽

Methicillin Resistant ◽

Diabetic Foot Infections ◽

Antibiotic Drug

Background Diabetic foot infection (DFI) is a serious, difficult-to-treat infection, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin has been the standard treatment for MRSA infection, but lower response rates in MRSA skin infections have been reported. This analysis assessed the outcome and safety of daptomycin therapy in patients with a DFI caused by MRSA. Methods Using the Cubicin Outcomes Registry and Experience and the European Cubicin Outcomes Registry and Experience (2006–2009), 79 patients with MRSA DFI were identified and included in this analysis. Results In the 74 evaluable patients, daptomycin was administered at a median dose of 4.8 mg/kg primarily every 24 hours (85.1%) and for a median of 15.0 days. Overall, 77.0% of the patients (57 of 74) received initial therapy with activity against MRSA; however, of patients receiving daptomycin as second-line therapy (n = 31), only 45.2% were treated with an antibiotic agent active against MRSA. The overall clinical success and treatment failure rates were 89.2% and 10.8%, respectively. Success with daptomycin therapy was higher in patients who had surgery and in those whose initial therapy was daptomycin. Eleven patients had 14 adverse events, two of which were possibly related to daptomycin use and led to discontinuation. Conclusions In a large real-world cohort of patients with MRSA DFI, daptomycin therapy was shown to be generally well tolerated and effective. The use of an anti-MRSA antibiotic agent should be considered when implementing first-line antibiotic drug therapy for DFI in countries where MRSA is common to avoid inappropriate empirical treatment and potential negative effects on outcomes.

Download Full-text

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

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620963570 ◽

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.

Download Full-text