scholarly journals Sonication of Kirschner Wire as a Tool for the Microbiological Diagnosis of Diabetic Foot Infection

2021 ◽  
Author(s):  
Rodrigo Cuiabano Paes Leme ◽  
Jéssica Reis Esteves Chaves ◽  
Luiz Carlos Soares Gonçalves ◽  
Leonardo César Alvim ◽  
João Roberto Chaves de Almeida ◽  
...  
Keyword(s):  
Stainless Steel ◽  
Diabetic Foot ◽  
Kirschner Wire ◽  
Microbiological Diagnosis ◽  
Diabetic Foot Infection ◽  
Biofilm Production ◽  
Conventional Methods ◽  
Tissue Specimens

We hypothesized that biofilm production occurs on stainless steel when incubated with tissue specimens in thioglycolate broth media (TBM). In a diabetic foot infection (DFI) cohort, applying the Kirschner wire and conventional methods were more sensitive than applying only the latter (CI 90%; 0.167 versus 0.375).

scholarly journals A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ying Huang ◽  
Ying Cao ◽  
Mengchen Zou ◽  
Xiangrong Luo ◽  
Ya Jiang ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Prospective Trial ◽  
Punch Biopsy ◽  
Gram Negative Bacteria ◽  
Deep Tissue ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
E Coli ◽  
Grade 3 ◽  
Tissue Specimens

Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection.Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n=10), grade 3 (n=29), and grade 4 (n=17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen.Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p=0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such asE. coliandCitrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such asSerratiaandRalstonia pickettii, were isolated from deep tissues but not from swabs.Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria.

scholarly journals Sonication of Kirschner Wire as a Tool for the Microbiological Diagnosis of Diabetic Foot Infection – Preliminary Results

2021 ◽  
Author(s):  
Rodrigo Paes Cuiabano Leme ◽  
Jéssica Chaves ◽  
Luiz Carlos Gonçalves ◽  
Leonardo César Alvim ◽  
João Roberto Chaves de Almeida ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Steel Wire ◽  
Statistical Significance ◽  
Kirschner Wire ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Culture Method ◽  
Wilcoxon Test ◽  
Tissue Samples ◽  
Diabetic Foot Infection

Background: Diabetic foot infection (DFI) is the commonest diabetic problem requiring hospital admission. Culture yield can be challenging, particularly in the presence of biofilms. Literature confirms biofilms are ubiquitous in diabetic foot ulcer, although, there is not a microbiologic diagnostic approach regarding biofilm disruption on DFI. We postulated sonicating a stainless-steel wire along with tissue samples into the thioglycollate broth media (TBM) may improve the diagnosis of DFI. Method: Pro-spective unicentric study that assessed patients with DFI who underwent surgical debridement. The vascular surgery team collected tissue fragments and inoculated the specimens into three TBM to execute the conventional culture method (CCM), and ad-ditional fragments to place into other TBM along with a Kirschner wire (K-wire – Kw method). The microbiologist processed the samples and the resultant sonication fluid in aerobic sheep-blood agar after 24 hours, 5 and 10 days of incubation. Both methods were compared (Wilcoxon test; p < 0.05). Results: The number of pathogens isolated in each method was not statistically significant (p = 0.414): CM = 1.67 (± 0.92); KwM = 1.75 (± 0.94). The KwM was not inferior to CCM. In addition, despite the absence of statistical significance, the KwM detected more pathogens than CCM.

scholarly journals Etiology of Diabetic Foot Infection in Patients with Poorly Controlled Diabetes

2013 ◽  
Vol 6 (1) ◽  
pp. 51-56
Author(s):  
Sergey D. Iliev ◽  
Lyubomir Ts. Beshev ◽  
Kiril L. Nedyalkov ◽  
Dobromir D. Nguen ◽  
Valentina E. Edreva-Besheva ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Bacterial Species ◽  
Anaerobic Bacteria ◽  
Clinical Signs ◽  
Deep Tissue ◽  
Tissue Samples ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
Anaerobic Infections ◽  
Tissue Specimens

SummaryThe aim of the study was to define the spectrum and susceptibility of microorganisms, isolated from diabetic foot ulcers in patients with poorly controlled diabetes, treated at the clinic of surgery, and compare microbial findings of specimens collected superficially and from deep tissues. The study included 19 patients with type 1 and 2 diabetes with clinical signs of infection. All patients were with poorly controlled diabetes and staged from 3rd to 5th grade according to the Wagner diabetic foot scale. Swab samples from non-debrided wounds and biopsy samples from deep tissues were collected from each patient. Specimens were inoculated on media for isolation of aerobic and anaerobic bacteria. Identification and susceptibility testing of the isolated oiganisms were performed by conventional methods, and VITEK 2 and mini API Systems (bioMerieux, France). A total of 88 bacterial isolates were cultured, comprising 56 clinical strains. Gram positive bacteria were the most common isolated organisms (53.57%), followed by Gram negative bacteria (26.78%) and anaerobic bacteria (19.64%). Staphylococcus aureus was the most common organism detected (10 strains), followed by Enterococcus spp. (7 strains), Escherichia coli (7 strains), Bacteroides spp. (6 strains) and various other organisms of low incidence. Polymicrobial infection was detected in 17 (89.47%) of the patients. In most of the cases infections were caused by 3 bacterial species. Mixed aerobic/anaerobic infections were detected in 9 (47.3%) patients. In 15 (78.94%) patients, there was a coincidence of bacterial findings from superficial and deep tissue samples. The strains isolated were susceptible to commonly used antimicrobials for treatment of diabetic foot infection. The predominant part of the diabetic foot infections were polymicrobial, caused by association between two or three microbial species. In half of the cases the infection was mixed. There was a good correlation between microbial findings from superficial swabs and deep tissue specimens when they were delivered to the microbiology laboratory immediately after collection.

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 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

The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

2021 ◽  
pp. 153473462110041
Author(s):  
Nese Saltoglu ◽  
Serkan Surme ◽  
Elif Ezirmik ◽  
Ayten Kadanali ◽  
Ahmet Furkan Kurt ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Initial Treatment ◽  
Methicillin Resistance ◽  
Major Amputation ◽  
Diabetic Foot Infection ◽  
Vascular Insufficiency ◽  
Klebsiella Spp

We aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 ± 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection ( p = .043) and vancomycin treatment ( p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency ( p = .004), hospital readmission ( p = .009), C-reactive protein > 130 mg/dL ( p = .007), and receiving carbapenems ( p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials.

scholarly journals Update on functional imaging in the evaluation of diabetic foot infection

2021 ◽  
Vol 16 ◽  
pp. 119-124
Author(s):  
Karthikeyan P. Iyengar ◽  
Vijay K. Jain ◽  
Muyed Kamal Awadalla Mohamed ◽  
Raju Vaishya ◽  
Sobhan Vinjamuri
Keyword(s):  
Functional Imaging ◽  
Diabetic Foot ◽  
Diabetic Foot Infection

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.

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