scholarly journals Culturomics Approach to Identify Diabetic Foot Infection Bacteria

2021 ◽  
Vol 22 (17) ◽  
pp. 9574
Author(s):  
Michał Złoch ◽  
Ewelina Maślak ◽  
Wojciech Kupczyk ◽  
Marek Jackowski ◽  
Paweł Pomastowski ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Culture Media ◽  
Bacterial Species ◽  
Microbial Composition ◽  
Diabetic Foot Infection ◽  
Flight Mass Spectrometry ◽  
Diabetic Foot Infections ◽  
Corynebacterium Striatum ◽  
Vancomycin Resistant ◽  
The Impact

The main goal of the study was to evaluate the usefulness of the culturomics approach in the reflection of diabetic foot infections (DFIs) microbial compositions in Poland. Superficial swab samples of 16 diabetic foot infection patients (Provincial Polyclinical Hospital in Toruń, Poland) were subjected to culturing using 10 different types of media followed by the identification via the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and Biotyper platform. Identified 204 bacterial isolates representing 18 different species—mostly Enterococcus faecalis (63%) and Staphylococcus aureus (44%). Most of the infections (81%) demonstrated a polymicrobial character. Great differences in the species coverage, the number of isolated Gram-positive and Gram-negative bacteria, and the efficiency of the microbial composition reflection between the investigated media were revealed. The use of commonly recommended blood agar allowed to reveal only 53% of the entire microbial composition of the diabetic foot infection samples, which considerably improved when the chromagar orientation and vancomycin-resistant enterococi agar were applied. In general, efficiency increased in the following order: selective < universal < enriched < differential media. Performed analysis also revealed the impact of the culture media composition on the molecular profiles of some bacterial species, such as Corynebacterium striatum, Proteus mirabilis or Morganella morganii that contributed to the differences in the identification quality. Our results indicated that the culturomics approach can significantly improve the accuracy of the reflection of the diabetic foot infections microbial compositions as long as an appropriate media set is selected. The chromagar orientation and vancomycin-resistant enterococi agar media which were used for the first time to study diabetic foot infection microbial profiles demonstrate the highest utility in the culturomics approach and should be included in further studies directed to find a faster and more reliable diabetic foot infection diagnostic tool.

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 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.

scholarly journals Diabetic Foot Infection: An Indian Scenario

2016 ◽  
Vol 3 (2) ◽  
pp. 71-79 ◽  
Author(s):  
Ashu Rastogi ◽  
Anil Bhansali
Keyword(s):  
Diabetic Foot ◽  
Bacterial Species ◽  
Asia Pacific ◽  
The West ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
Foot Complications ◽  
Foot Problems ◽  
Indian Scenario

ABSTRACT Introduction Diabetes mellitus is assuming epidemic proportions and with that an increasing burden of diabetic foot complications. Diabetic foot infections (DFIs) contribute not only to morbidity, amputation, and increased health-care costs but also to mortality. Aim To review the literature regarding the epidemiology and management of DFIs in India. Results The socioepidemiology of diabetic foot and its complications in India is different from the West. There is a considerable delay in seeking a physician for foot problems, as patients continue invalidated and indigenous methods of treatment. At presentation, most of the foot ulcers are chronic, harbor infection, and neuropathic in origin compared to the West with predominantly neurovascular ulcers. A predominance of Gram-negative bacterial species is reported in DFIs, with Pseudomonas aeruginosa as the most common isolated organism. An initial empirical antibiotic choice covering Gram-negative bacteria is suggested. Conclusion There are very few studies on the countrywide prevalence of foot complications from India. In India, DFIs behave differently from the West because of sociocultural and economic differences. We need indigenous ways for prevention and management of DFIs in India. How to cite this article Rastogi A, Bhansali A. Diabetic Foot Infection: An Indian Scenario. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):71-79.

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

scholarly journals 1309. The Impact of Clinical Practice Guideline Using Educational Intervention for Improvement of Diabetic Foot Infections Treatment Outcomes

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S400-S400
Author(s):  
Mullika Phangmuangdee ◽  
Oranich Navanukroh ◽  
Pornpan Koomanachai
Keyword(s):  
Clinical Practice ◽  
Educational Intervention ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Diabetic Foot ◽  
Unfavorable Outcome ◽  
Secondary Outcome ◽  
Diabetic Foot Infections ◽  
The Impact ◽  
Microbiological Data

Abstract Background Diabetic foot infections (DFIs) are important cause of lower-extremity amputation. The inappropriate empirical antimicrobial therapy for DFI was associated with amputation. We created the Clinical Practice Guideline (CPG) of empirical antimicrobial (ATB) therapy for in-patients with DFIs. The primary outcome of present study was to evaluate the intervention using educate and training the surgeons to adhere with CPG. The secondary outcome was the decreasing of unfavorable outcome (amputations). Methods A prospective study of CPG implementation for treatment in adult in-patients who had DFIs was conducted at surgical and orthopedics wards. The CPG was developed by the investigator team based on the data from our previous study (submitted to publish). CPG was presented monthly to train the orthopedic and vascular surgeons for 1 year. The empirical ATB regimens were prescribed by the responsible surgeon who was trained to use CPG. Demographics data, wound characteristics, microbiological data, ATB therapy, and clinical outcome were recorded. The appropriate empirical ATB treatment was determined by investigators weather CPG matched or microbiological matched. The adherence to CPG, the appropriate empirical ATB, and the unfavorable outcome were analyzed. All data were reported by descriptive and inferential statistics. Results A total of 85 DFIs patients were enrolled. The patients received the appropriate empirical ATB matched to CPG and matched to microbiological data, were 87% and 67%, respectively. The unfavorable outcome was 26% while previously was 72.4% (submitted to publish data) before CPG implementation. The independent factors associated with unfavorable outcomes were (1) an inappropriate ATB and (2) infections with drug-resistant pathogens (adjusted relative ratio; aRR 2.98; 95% CI: 1.36–6.55, P = 0.007 and aRR 1.90; 95% CI: 1.05–3.43, P = 0.034, respectively). Conclusion The current study demonstrated that mothly training of CPG resulting in the high adherence (87%) of CPG use and resulting in high rate of appropriate empirical ATB. Educational intervention insisted the responsible physician for administration the appropriate ATB with the improvement of unfavorable outcome in DFIs. Disclosures All authors: No reported disclosures.

scholarly journals Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening for Patients with a Diabetic Foot Infection

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Kari A. Mergenhagen ◽  
Michael Croix ◽  
Kaitlyn E. Starr ◽  
John A. Sellick ◽  
Alan J. Lesse
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
International Classification Of Diseases ◽  
Methicillin Resistant ◽  
Content Type ◽  
Diabetic Foot Infection ◽  
Entire Cohort ◽  
Diabetic Foot Infections ◽  
Medical Centers ◽  
Classification Of Diseases

ABSTRACT Treatment of suspected methicillin-resistant Staphylococcus aureus (MRSA) is a cornerstone of severe diabetic foot infections; however, antibiotics can be associated with toxicity. The objective of this study was to determine the negative predictive value (NPV) of MRSA nares screening in the determination of subsequent MRSA in patients with a diabetic foot infection. This was a retrospective cohort study across Veterans Affairs (VA) medical centers from 1 January 2007 to 1 January 2018. Data from patients with an International Classification of Diseases (ICD) code for a diabetic foot infection with MRSA nares screening, and subsequent cultures were evaluated for the presence of MRSA. NPVs were calculated for the entire cohort, as well as for a subgroup representing deep cultures. Additionally, the distribution of all pathogens isolated from diabetic foot infections was determined. A total of 8,163 episodes were included in the analysis for NPV. The NPV of MRSA nares screening for MRSA diabetic foot infection was 89.6%. For the deep cultures, the NPV was 89.2%. The NPV for cultures originating from the foot was 89.7%, and the NPV for those originating from the toe was 89.4%. There were 17,822 pathogens isolated from the diabetic foot cultures. MRSA was isolated in 7.5% of cultures, and methicillin-susceptible S. aureus was isolated in 24.8%. Enterococcus was identified in 14.7% of cultures, Proteus in 7.3%, and Pseudomonas in 6.8% of cultures. Given the high NPVs, the use of MRSA nares screening may be appropriate as a stewardship tool for deescalation and avoidance of empirical anti-MRSA therapy in patients who are not nasal carries of MRSA.

The Impact of Hospitalization for Diabetic Foot Infection on Health-Related Quality of Life: Utilizing PROMIS

2021 ◽  
Author(s):  
Matthew J. Johnson ◽  
Dane K. Wukich ◽  
Paul A. Nakonezny ◽  
Lawrence A. Lavery ◽  
Javier La Fontaine ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Health Related Quality ◽  
Diabetic Foot Infection ◽  
Related Quality ◽  
Health Related ◽  
The Impact

scholarly journals Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection

2012 ◽  
Vol 109 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Shalbha Tiwari ◽  
Daliparthy D. Pratyush ◽  
Balram Gupta ◽  
Awanindra Dwivedi ◽  
Sandeep Chaudhary ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Diabetic Foot ◽  
Vitamin D Supplementation ◽  
Diabetic Patients ◽  
Similar Data ◽  
Diabetic Foot Infection ◽  
Hydroxyvitamin D ◽  
Severe Vitamin ◽  
Diabetic Foot Infections

The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (sd 38·35) v. 50·75 (sd 33·00); P < 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D < 75 nmol/l) was equally common in cases and controls (OR 1·45, 95 % CI 0·8, 3·0; P = 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D < 50 nmol/l) than controls (OR 1·8, 95 % CI 1·1, 3·0; P = 0·02). Risk of severe vitamin D deficiency (25(OH)D < 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95 % CI 2·4, 6·9; P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency ( < 25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies.

scholarly journals Tracking Anti-Staphylococcus aureusAntibodies ProducedIn VivoandEx Vivoduring Foot Salvage Therapy for Diabetic Foot Infections Reveals Prognostic Insights and Evidence of Diversified Humoral Immunity

2018 ◽  
Vol 86 (12) ◽  
Author(s):  
Irvin Oh ◽  
Gowrishankar Muthukrishnan ◽  
Mark J. Ninomiya ◽  
James D. Brodell ◽  
Benjamin L. Smith ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Salvage Therapy ◽  
Mononuclear Cells ◽  
Characteristic Curve ◽  
Bacterial Species ◽  
Etiologic Agent ◽  
Peripheral Blood Mononuclear ◽  
Content Type ◽  
Diabetic Foot Infections ◽  
Antibody Titers

ABSTRACTManagement of foot salvage therapy (FST) for diabetic foot infections (DFI) is challenging due to the absence of reliable diagnostics to identify the etiologic agent and prognostics to justify aggressive treatments. AsStaphylococcus aureusis the most common pathogen associated with DFI, we aimed to develop a multiplex immunoassay of IgG in serum and medium enriched for newly synthesized anti-S. aureusantibodies (MENSA) generated from cultured peripheral blood mononuclear cells of DFI patients undergoing FST. Wound samples were collected from 26 DFI patients to identify the infecting bacterial species via 16S rRNA sequencing. Blood was obtained over 12 weeks of FST to assess anti-S. aureusIgG levels in sera and MENSA. The results showed that 17 out of 26 infections were polymicrobial and 12 were positive forS. aureus. While antibody titers in serum and MENSA displayed similar diagnostic potentials to detectS. aureusinfection, MENSA showed a 2-fold-greater signal-to-background ratio. Multivariate analyses revealed increases in predictive power of diagnosingS. aureusinfections (area under the receiver operating characteristic curve [AUC] > 0.85) only when combining titers against different classes of antigens, suggesting cross-functional antigenic diversity. Anti-S. aureusIgG levels in MENSA decreased with successful FST and rose with reinfection. In contrast, IgG levels in serum remained unchanged throughout the 12-week FST. Collectively, these results demonstrate the applicability of serum and MENSA for diagnosis ofS. aureusDFI with increased power by combining functionally distinct titers. We also found that tracking MENSA has prognostic potential to guide clinical decisions during FST.

scholarly journals A Decade of Development of Chromogenic Culture Media for Clinical Microbiology in an Era of Molecular Diagnostics

2017 ◽  
Vol 30 (2) ◽  
pp. 449-479 ◽  
Author(s):  
John D. Perry
Keyword(s):  
New Media ◽  
Molecular Diagnostics ◽  
Clinical Microbiology ◽  
Culture Media ◽  
Group B Streptococci ◽  
Widespread Application ◽  
Content Type ◽  
Flight Mass Spectrometry ◽  
Group B ◽  
The Impact

SUMMARYIn the last 25 years, chromogenic culture media have found widespread application in diagnostic clinical microbiology. In the last decade, the range of media available to clinical laboratories has expanded greatly, allowing specific detection of additional pathogens, includingPseudomonas aeruginosa, group B streptococci,Clostridium difficile,Campylobacterspp., andYersinia enterocolitica. New media have also been developed to screen for pathogens with acquired antimicrobial resistance, including vancomycin-resistant enterococci, carbapenem-resistantAcinetobacterspp., andEnterobacteriaceaewith extended-spectrum β-lactamases and carbapenemases. This review seeks to explore the utility of chromogenic media in clinical microbiology, with particular attention given to media that have been commercialized in the last decade. The impact of laboratory automation and complementary technologies such as matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) is also assessed. Finally, the review also seeks to demarcate the role of chromogenic media in an era of molecular diagnostics.

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