Diabetic foot infection and its recurrence: a retrospective study from an academic center in Belgium

BACKGROUND: Diabetic foot infection is a major cause of patient disabilities and lowers limb amputations, with high treatment costs and hospitalisation requirements. AIM: Aim of this study was to evaluate surgical wound care plus antibiotic effects in the treatment of mild and moderate diabetic foot infections. METHODS: This retrospective study involved 60 patients with diabetic foot infections with or without osteomyelitis. The patients were categorised as group 1 mild and group 2 moderate. Both groups were treated using local wound debridement and the systemic administration of antibiotics. Group 1 (16) patients were treated with two regimens of oral antibiotics in two regimens, A (amoxicillin/clavulanate + metronidazole) and B (clindamycin + metronidazole), for 10-14 days. Group 2 (42) patients were treated with oral plus intravenous antibiotics in two regimens, A (ampicillin + cloxacillin + metronidazole) and B (lincomycin + metronidazole), for 6 weeks. The patients followed-up with local wound care specialists for 3 months to evaluate the treatment outcomes (cure, improvement, or failure). RESULTS: Group 1 had an 80% cure rate under regimen A and a 100% cure rate under regimen B. Group 2 regimen A patients had a 61.5% cure rate and 11.53% improved, while regimen B patients had a 68.75% cure rate and 12.5% improved. Failure in both regimens was 23.8% in 20 patients with osteomyelitis, while 35% were cured and 20% improved during the study period. CONCLUSION: Local surgical wound care for 3 months with antibiotic regimens for 6 weeks resulted in good response and cure rates, with lower costs and fewer instances of hospitalisation. Intravenous lincomycin and oral metronidazole achieved higher cure responses for moderate diabetic foot infections.

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Epidemiology of the Diabetic Foot Infection in a Tertiary Care Hospital in the Lebanon: A Retrospective Study between 2000 and 2011

Archives of Infectious Diseases & Therapy ◽

10.33140/aidt.02.03.05 ◽

2018 ◽

Vol 2 (3) ◽

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Retrospective Study ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Care Hospital ◽

Complications Of Diabetes ◽

Diabetic Foot Infection ◽

Diabetic Foot Infections ◽

History Of

Objectives: Describe the epidemiology of diabetic foot infections in Lebanon as well as the demographic and clinical characteristics of the patients. Study the microbiology of the infections and the bacterial resistances in the infected diabetic foot ulcers, in order to help reach an optimal care in the healthcare establishments. Materials and methods: A retrospective study between January, 2000 and Mars, 2011 of medical cases of 167 hospitalized patients for diabetic foot infection at the Hospital Hôtel-Dieu of France in Beirut, Lebanon. Results: The average age of the patients was 66 years, and males represented 73.65 %. The duration of diabetes was 20 years with a percentage of HbA1C >7 % in 79 % of the cases. 73.17 % of the patients had peripheral arteriopathy, 72.3 % peripheral neuropathy. Other complications of diabetes were associated: coronary problems (49.69 %), retinopathy (48.67 %) and renal disease (47.65 %). High blood pressure was found in 60.38 % of the cases, dyslipidemia in 48.73 %. Pseudomonas aeruginosa was the most frequently isolated bacteria from diabetic foot infections (19.15 %), followed by Escherichia coli (11.91 %), Staphyloccocus aureus (11.06 %), and of Enteroccocus fecalis (11.06 %). Most prescribed antibiotics were: pipéracllin/tazobactam, amoxicillin/clavulanic acid, and imipenme. Amputation was necessary in 36.3 % of the cases. The main risk factors of amputation, besides the infection itself, were history of amputation and arteriopathy Conclusion: In the Lebanese population, the diabetic foot disease takes the aspect of pathology with male ascendancy, which affects, late in their lives, patients with a long-time, badly controlled diabetes. Often, several complications of diabetes are present associated, in particular arteriopathy and peripheral neuropathy. Pseudomonas aeruginosa was the most frequently isolated bacteria from diabetic foot infections in Lebanon. The amputation rate remains high: 36.3 %, with arteriopathy and history of amputation as risk factors.

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Levofloxacin-Induced Photosensitivity Mimicking Severe Cellulitis in a Patient with Diabetic Foot Infection

MOJ Clinical & Medical Case Reports ◽

10.15406/mojcr.2017.07.00221 ◽

2017 ◽

Vol 7 (6) ◽

Author(s):

CV Loupa

Keyword(s):

Diabetic Foot ◽

Diabetic Foot Infection

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Syme Ankle Disarticulation in Peripheral Vascular Disease and Diabetic Foot Infection: The One-Stage versus Two-Stage Procedure

Foot & Ankle International ◽

10.1177/107110079501600303 ◽

1995 ◽

Vol 16 (3) ◽

pp. 124-127 ◽

Cited By ~ 25

Author(s):

Michael S. Pinzur ◽

Douglas Smith ◽

Helen Osterman

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Diabetic Foot ◽

Stage Versus ◽

Peripheral Vascular ◽

Two Stage ◽

Diabetic Foot Infection ◽

One Stage ◽

The One

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

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734621992290 ◽

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.

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

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i1.44683 ◽

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

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

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211004141 ◽

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.

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