Risk Factors for Infection with Pseudomonas aeruginosa in Diabetic Foot Infections

2017 ◽  
Vol 107 (6) ◽  
pp. 483-489 ◽  
Author(s):  
Bulent M. Ertugrul ◽  
Benjamin A. Lipsky ◽  
Mevlut Ture ◽  
Serhan Sakarya
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Statistical Significance ◽  
Empirical Therapy ◽  
Wound Dressings ◽  
Factors Affecting ◽  
Diabetic Foot Infections ◽  
History Of ◽  
Epidermal Growth

Background: Selecting empirical therapy for a diabetic foot infection (DFI) requires knowing how likely infection with Pseudomonas aeruginosa is in a particular patient. We designed this study to define the risk factors associated with P aeruginosa in DFI. Methods: We performed a preplanned microbiological subanalysis of data from a study assessing the effects of treatment with intralesional epidermal growth factor for diabetic foot wounds in patients in Turkey between January 1, 2012, and December 31, 2013. Patients were screened for risk factors, and the data of enrolled individuals were recorded in custom-designed patient data forms. Factors affecting P aeruginosa isolation were evaluated by univariate and multivariate logistic regression analyses, with statistical significance set at P < .05. Results: There were 174 patients enrolled in the main study. Statistical analysis was performed in 90 evaluable patients for whom we had microbiological assessments. Cultures were sterile in 19 patients, and 89 bacterial isolates were found in the other 71. The most frequently isolated bacteria were P aeruginosa (n = 23, 25.8%) and Staphylococcus aureus (n = 12, 13.5%). Previous lower-extremity amputation and a history of using active wound dressings were the only statistically significant independent risk factors for the isolation of P aeruginosa in these DFIs. Conclusions: This retrospective study provides some information on risk factors for infection with this difficult pathogen in patients with DFI. We need prospective studies in various parts of the world to better define this issue.

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

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.

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

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.

scholarly journals Risk Factors for Pseudomonas aeruginosa in Diabetic Foot Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S108-S108 ◽  
Author(s):  
Nada Farhat ◽  
Daniel McClung ◽  
Jerod Nagel
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Treatment Options ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Current Smoker ◽  
Retrospective Case ◽  
Diabetic Foot Infections ◽  
Severe Infections

Abstract Background Infectious Diseases Society of America guidelines for the management of diabetic foot infections (DFIs) suggest 15 different antibiotic treatment options for moderate-to-severe infections. All treatment options provide coverage for Gram-positive cocci, and some provide coverage for Gram-negative pathogens, including Pseudomonas aeruginosa (PSA). However, there is minimal guidance in determining which patients require anti-PSA therapy. Methods This single-center retrospective case–control study included patients hospitalized between October 2013 and September 2015. Adult patients admitted with a DFI were identified using a combination of ICD-9 codes for diabetes with complications and cellulitis. The primary outcome was identification of risk factors associated with PSA DFIs. A multivariable model using logistic regression was constructed, and a receiver operator characteristic (ROC) curve was generated to assess the sensitivity and specificity of the model. Results 262 patients were included and 12 (4.6%) patients had cultures with PSA. Multivariable analysis yielded six risk factors for PSA DFIs (see Table). ROC construction yielded an area under the curve of 0.895. Conclusion The incidence of PSA from DFIs is low. A model with excellent performance characteristics demonstrated that risk factors for PSA DFIs include age > 65, BMI ≥ 35, former or current smoker, history of lower extremity bypass procedure, and cardiovascular disease. Future validation of these factors could help stewardship programs reduce unnecessary antibiotic utilization. Disclosures All authors: No reported disclosures.

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

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.

scholarly journals Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098739
Author(s):  
Yuxia Cheng ◽  
Ping Zu ◽  
Jie Zhao ◽  
Lintao Shi ◽  
Hongyan Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Blood Glucose Control ◽  
Diabetes Duration ◽  
Chinese Patients ◽  
Foot Care ◽  
Vascular Intervention ◽  
History Of ◽  
Independent Risk Factors ◽  
Recurrence Group

Objective To investigate the characteristics of diabetic foot ulcer (DFU) recurrence. Methods A total of 573 patients with DFUs were recruited and divided into an initial group (395 patients) and a recurrence group (178 patients). The factors related to recurrence were analyzed using multivariate regression. Results The recurrence group had longer diabetes duration (odds ratio [OR] 192; 95% confidence interval 120, 252 vs. 156; 96, 240); lower glycated hemoglobin levels (OR 8.1; 95% CI 6.8, 9.6 vs. 9.1; 7.4, 10.5), and higher rates than the initial group of amputation (37.5% vs. 2.0%), history of vascular intervention (21.3% vs. 3.9%), retinopathy (77.7% vs. 64.7%), callus (44.4% vs. 20.8%), foot deformity (51.2% vs. 24.6%), and outdoor sports shoe wearing (34.0% vs. 21.2%). Multiple factor logistic regression analysis showed that diabetes duration (OR 1.004), callus (OR 2.769), vascular intervention (OR 2.824) and amputation (OR 22.256) were independent risk factors for DFU recurrence. Conclusion Diabetes duration, callus, history of vascular intervention, and amputation were independent risk factors for recurrent DFUs in a cohort of Chinese patients with active DFU. The prevention and treatment of DFUs, especially callus treatment, foot care, and blood glucose control, should be improved in China.

scholarly journals HEMOGLOBIN STATUS OF FEMALE MEDICOS IN URBAN AREA AND FACTORS AFFECTING IT: AN OBSERVATIONAL CROSS-SECTIONAL STUDY

2017 ◽  
Vol 10 (3) ◽  
pp. 439
Author(s):  
Drpadmajauday Kumar ◽  
Varsha Kalyanpur
Keyword(s):  
Statistical Significance ◽  
Cross Sectional Study ◽  
Leafy Vegetables ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Green Leafy Vegetables ◽  
Nutritional Anemia ◽  
Mild Anemia ◽  
History Of

ABSTRACTObjectives: Estimating the hemoglobin (Hb) status in female medicos through prospective cross-sectional study and assessment of influencing ofcofactors were objectives.Methods: Women medicos who volunteered, consented and met selection criteria were enrolled. Hb level was estimated to diagnose anemia.Relationship with influencing factors was assessed statistically.Result: A total of 100 eligible students were enrolled. Mean age±standard deviation (SD) age of the participants’ was 20.9±3.1 years (17-25 years).Mean±SD Hb was 12.25±1.0189 g% (9.0-16.0 g%). 33 were anemic, and mild anemia (32%) was frequent. There was a history of worm infestation inthree students (3%), who were treated adequately. Nine were on iron supplements of which five were still anemic and were continuing the treatmentby the end of the study. 28 (84.84%) anemic students were not on any iron or hematinic treatment. There was no association between the anemiaand nature of diet, consumption of green leafy vegetables, consumption of coffee/tea after food, smoking/tobacco or alcohol consumption, mother’seducation, socioeconomic status, menstrual factors, and physical exercise. The prevalence of anemia was found to be higher in underweight andoverweight students in comparison to students with normal body mass index.Asymptomatic participants (n=78) outnumbered symptomatic ones(n=22), but without any statistical significance. Easy fatigability (14%), pallor (7%), breathlessness (6%), weakness (9%), and easy bruising (1%)were frequent complaints.Conclusion: Anemia is frequent among women medicos, often underdiagnosed, under-reported, many remaining asymptomatic. Negligence ofmedical students toward their anemic status despite the awareness of consequences of low Hb level is a serious cause of concern.Keywords: Awareness, Hemoglobin, Nutritional anemia, Women medical students.

scholarly journals Diabetic Foot Risk Factors and Effectiveness of Education in Saudi Arabia

2021 ◽  
pp. 48-53
Author(s):  
Mohammad Saqib Siddiqui ◽  
Abdulaziz Fehaid Alotaibi ◽  
Fahad Mohammed Saeed Alharthi ◽  
Abdullatif Meshal Almalawi ◽  
Ahmed Zayed Asiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Saudi Arabia ◽  
Diabetic Foot ◽  
Management Practices ◽  
Diabetes Education ◽  
Previous History ◽  
Diabetic Patients ◽  
History Of ◽  
Artery Disease ◽  
Educational Campaigns

Diabetes mellitus (DM) is a chronic disease with a remarkable global burden on the affected patients and healthcare systems. Among the reported complications, the diabetic foot has been reported to be a common one, which might be disabling, resulting in related amputations. Furthermore, we will provide evidence regarding the effect of education on the awareness and knowledge of diabetic Saudis about diabetic foot risk factors and management practices. Different risk factors were reported for developing diabetic foot among patients with DM. These will be studied in the current literature review, focusing on evidence that was conducted in Saudi Arabia. Age, gender, type of diabetes, education, duration of the disease, peripheral neuropathy, erythrocyte sedimentation rate, peripheral vascular disease, ischemic heart disease, renal artery disease, having a previous history of diabetic foot, and hypertension were all reported to be significant factors that were associated with the risk of developing diabetic foot across the Kingdom. The level of knowledge was variable across the different investigations. However, there is a poor attitude in general about the appropriate care practices of diabetic foot. Although it has been demonstrated that educational campaigns are effective, further efforts are still needed to increase awareness and attitude levels among diabetic patients in Saudi Arabia.

Diabetic Foot Infections

2016 ◽  
Author(s):  
Clare Kelleher
Keyword(s):  
Diabetic Foot ◽  
Prior History ◽  
Diabetic Foot Infections ◽  
Definitive Therapy ◽  
Empiric Antibiotic ◽  
History Of ◽  
Mrsa Infection ◽  
Systemic Manifestations ◽  
Purulent Drainage ◽  
Incision Drainage

Diabetic foot infections (DFI) are diagnosed by two or more classic findings of inflammation (redness, swelling, warmth, and tenderness) or purulent drainage within an existing diabetic foot wound. Wounds without clinical evidence of soft tissue or bone infection often do not require antibiotic therapy. When infection is present, empiric antibiotic regimens must be based on the available clinical and local epidemiologic data, but definitive therapy should be based on cultures of infected tissues or clinical response. Consideration of methicillin-resistant Staphylococcus aureus (MRSA) coverage should be given when local prevalence is high, in patients with a prior history of MRSA infection, or when the systemic manifestations are severe. Surgical intervention and vascular assessment play key roles in the management of many DFI; deep DFI require incision, drainage, and debridement. Redistribution of pressure off of the wound is a tenet in the management of DFI.

scholarly journals Evaluation of risk factors and drug adherence in the occurrence of stroke in patients with atrial fibrillation

2020 ◽  
Vol 18 (2) ◽  
pp. 1860
Author(s):  
Maya Hajj ◽  
Roula Ajrouche ◽  
Salam Zein ◽  
Samar Rachidi ◽  
Sanaa Awada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Statistical Significance ◽  
Adherence To Medication ◽  
High Adherence ◽  
Adherence Scale ◽  
History Of ◽  
History Of Obesity ◽  
Anticoagulant Medication ◽  
Reduced Risk

Background: Atrial fibrillation (AF) patients are at high risk of developing a stroke and anticoagulant medications are generally prescribed to prevent stroke in AF population. Objective: This study aims to evaluate stroke risk factors among hospitalized patients with AF and to assess the level of adherence to medications in AF patients and their relation with stroke. Methods: This is a case-control study conducted between June 1st, 2018 and December 31th, 2018 among AF patients admitted to seven tertiary Lebanese hospitals. Data were collected using a standardized questionnaire. Adherence to medications was assessed using the Lebanese Medication Adherence Scale-14. Odds ratios (OR) expressed the strength of association between the independent variables and the dependent variable and were estimated using unconditional logistic regression adjusted for confounding factors. P<0.05 determined statistical significance. Results: In total, 174 cases of AF patients were included with 87 cases and 87 controls. The risk of stroke among AF significantly increased with the presence of a history of hypertension, aOR 16.04 (95%CI, 2.27-113.37; p=0.005), history of coronary heart disease/myocardial infarction, and history of obesity. Anticoagulant medication significantly decreased the risk of stroke among AF patients, aOR 0.27 (95%CI, 0.07-0.98; P=0.047). High adherence to medications was significantly associated with a reduced risk of stroke, aOR 0.04 (95%CI, 0.01-0.23; p<0.001). Conclusions: Having a history of hypertension is one of the strongest risk factors for stroke among AF patients in Lebanon. While anticoagulant medication use was associated with a reduced risk for stroke, high adherence to medications is critical for stroke prevention. Public health interventions are needed to tackle low-adherence to medication and prevent stroke among AF patients.

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