Effects of pH on the Antibiotic Resistance of Bacteria Recovered from Diabetic Foot Ulcer Fluid

2018 ◽  
Vol 108 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Carla D. McArdle ◽  
Katie M. Lagan ◽  
David A. McDowell
Keyword(s):  
Antibiotic Resistance ◽  
Diabetic Foot ◽  
Bacterial Infections ◽  
Clinical Decision Making ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Clinical Decision ◽  
Wound Fluid ◽  
Ph Values ◽  
Diabetic Foot Infections

Background: This study investigated the resistance of bacteria isolated from diabetic foot ulcers (DFUs) to antibiotics frequently used in the management of the diabetic foot infections, at a range of pH values (pH 6.5, 7.5, and 8.5) known to exist in DFU wound fluid. This study aimed to determine whether changes (or atypical stasis) in wound fluid pH modulate the antibiotic resistance of DFU isolates, with potential implications in relation to the suppression/eradication of bacterial infections in DFUs. Methods: Thirty bacterial isolates were recovered from DFU wound fluid, including Staphylococcus spp, Staphylococcus aureus, Escherichia coli, Streptococcus spp, Pseudomonas spp, and Pseudomonas aeruginosa. The resistances of these isolates to a panel of antibiotics currently used in the treatment of infected or potentially infected DFUs, ie, ciprofloxacin, amoxicillin-clavulanate, doxycycline, and piperacillin-tazobactam, at the previously mentioned pH values were determined by a modification of the Kirby-Bauer assay. Results: The resistance of DFU isolates to clinically relevant antibiotics was significantly affected by the pH levels in DFU wound fluid. Conclusions: These findings highlight the importance of a more comprehensive understanding of the conditions in DFUs to inform clinical decision making in the selection and application of antibiotics in treating these difficult-to-heal wounds. The scale of the differences in the efficacies of antibiotics at the different pH values examined is likely to be sufficient to suggest reconsideration of the antibiotics of choice in the treatment of DFU infection.

scholarly journals DIABETIC FOOT INFECTIONS;

2008 ◽  
Vol 15 (01) ◽  
pp. 153-161
Author(s):  
MUHAMMAD SAEED AKHTAR ◽  
MAQSOOD AHMAD ◽  
MUHAMMAD BADAR BASHIR ◽  
Muhammad Irfan ◽  
Zahid Yasin Hashmie
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Surgical Department ◽  
Diabetic Foot Infections ◽  
Group A ◽  
Hospital Stays ◽  
Male Patients ◽  
Group B

Objective: (1) To evaluate the effects of G-CSF in eliminating infection in diabetic foot wound (2) Tocompare the effects with conventional diabetic foot management. Design: Prospective, open, randomized comparativestudy. Setting: Medical&Surgical Department of Allied, DHQ Hospital & Nawaz Medicare Faisalabad. Period: FromJan 2000 to Nov 2000 Patients & Methods: Fifty diabetic patients with foot infections were included in this study. Themean age was 52 years ranging from 27 to 60 years. They were divided into two equal groups(Group A and Group B).Results: The male patients were 41(82%) and female 9(18%). Forty six percent of patients were on oral hypoglycaemicdrugs, and 54% on insulin. The trauma preceding infection was 20%, Peripheral neuropathy 94% and peripheralvascular disease 34%. Thirty two percent of patients were smoker. Group A were subjected to G-CSF ( Neupogen )therapy (n=25) subcutanously daily for 5days in addition to conventional measures. Whereas patients in Group Breceived only conventional therapy. Both groups received similar antibiotic and insulin treatment. G-CSF therapy wasassociated with earlier eradication of pathogens from the infected ulcer (median 5 [range 2-11] vs11 [6-31] days in thegroup B; (p=<O.000I), quicker resolution of cellulitis (6 vs l4 days; p<O.0001), shorter hospital stay (8 vsl6 days;p<O.000l), and a shorter duration of intravenous antibiotic treatment (7 vs l4 days ;p—0.0001).No G-CSF treatedpatient needed surgery, whereas three patients in group B underwent toe amputation and six had extensivedebridement under anaesthesia (p=0.00 1). G-CSF therapy was generally well tolerated. Conclusion: Granulocytecolony stimulating factor (G-CSF) may be used as a good adjuvant therapy along with conventional measures for themanagement of diabetic foot infection, as it promotes the healing of diabetic foot ulcer/cellulitis and consequentlyprevents many hazardous complications like amputation of limbs, long hospital stays, extensive and prolonged antibioticuse and last but not the least the total misery of the patients.

scholarly journals Staged salvage of diabetic foot with Chopart amputation and intramedullary nailing

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110467
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Fábio Correa Fonseca ◽  
Cesar de Cesar-Netto ◽  
Katrina Bang ◽  
Eduardo Araujo Pires ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Weight Bearing ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Gait Pattern ◽  
Distal Stump ◽  
Diabetic Ulcer ◽  
Pressure Therapy ◽  
Diabetic Foot Infections ◽  
Amputation Stump

We present a stepwise surgical approach that can be used, in lieu of a transtibial amputation, to preserve the lower limb in the setting of severe diabetic foot infections. A 63-year-old male status post left midfoot (Lisfranc’s) amputation presented to our hospital with a 4-year history of a left foot diabetic ulcer with associated purulent drainage and intermittent chills. On initial exam, the patient’s left foot amputation stump was plantarflexed, grossly erythematous, and edematous. The associated diabetic foot ulcer was actively draining purulent fluid. Following workup with radiography and ultrasound, the patient was diagnosed with a post-operative infection of the midfoot at the level of the amputation stump secondary to diabetic neuropathy. Our approach to management was a staged and included (1) surgical irrigation and debridement of the distal stump wound, (2) provisional negative pressure therapy, (3) a second-look procedure, and (4) a tibiotalocalcaneal fusion was performed using a lateral transfibular and plantar approach, after wound closure and resolution of active infection was achieved. At 36-month follow-up, the patient was fully weight-bearing in stiff sole sneakers with no gross overt alteration of gait pattern. The patient scored 79 points when assessed by the hindfoot American Orthopaedic Foot and Ankle Society Ankle-Hindfoot outcome score. In the patient with diabetes and cardiological restrictions, a Chopart amputation is preferred due to the decreased level of energy expenditure required for ambulation as compared to over more proximal levels of amputation.

scholarly journals Wound Myiasis in Diabetic Foot Ulcer: Calliphoridae and Sar-cophagidae Family

2021 ◽  
Author(s):  
Evren Tileklioğlu ◽  
İbrahim Yildiz ◽  
Fürüzan Bozkurt Kozan ◽  
Erdoğan Malatyali ◽  
Mustafa Bülent Ertuğrul ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Wound ◽  
Developmental Stages ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Foot Infections ◽  
Third Stage ◽  
Wound Myiasis

Background: Myiasis is a parasitic infestation of tissues or body cavities of mammals with dipterous larvae. The patients with diabetic foot ulcers are more vulnerable to acquiring infestation; however, the infestation may be neglected and mistreated in some cases.  Methods: Data were collected of twelve myiasis cases with diabetic foot ulcers in Nazli-Selim Eren Chronic Wound and Infections Care Unit, Aydin, Turkey between 2017 and 2019. Demographic, clinical characteristics of the patients and clinical examination of the wound were recorded. To morphology-based identification method of the agents, the developmental stages of the maggots were examined. Results: The cases aged between 46 and 81 years (10 males, two females). Eight of the larvae collected from wounds had Calliphoridae and four had Sarcophagidae family. The larvae were infested right/left foot sole, thumb, ankle, and mostly left toes. The number of larvae collected from the cases ranged from 2 to 48. Third-stage larvae (L3) were mostly detected. Mixed (L1-L2, L2-L3) larvae were detected in a patient. The infestations were more common in July and August. According to the score of Infectious Diseases Society of America (IDSA), ten (83%) cases had moderate and two (17%) cases were mild diabetic foot infections (DFIs). Conclusion: Diabetic foot ulcers should be evaluated in terms of myiasis. This was the first study in our province indicating that myiasis should not be neglected and different species of flies were responsible for myiasis cases.

scholarly journals Diabetes a risk for antimicrobial resistance?

2017 ◽  
Vol 6 (12) ◽  
pp. 2811 ◽  
Author(s):  
Vasavi Gedela ◽  
Sree Lakshmi Gosala
Keyword(s):  
Antimicrobial Resistance ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Resistance Pattern ◽  
Causative Organism ◽  
Diabetic Patients ◽  
Diabetic Foot Infections ◽  
Significant Difference ◽  
Resistance Rates

Background: Diabetic foot infections can cause substantial morbidity. The role of Diabetes mellitus in the antimicrobial resistance of pathogens in patients with foot infections is not well clarified. So, we compared the profile of antibiotic resistance in diabetic and non-diabetic foot ulcer infections. Objectives were to compare the antimicrobial resistance pattern in diabetic and non-diabetic lower limb infections.Methods: T Pus was isolated in 50 Diabetic and 50 non-diabetic foot ulcer infections. The organisms were isolated on specific media and antibiotic susceptibility was done by using Kirby-Bauer disc diffusion method.Results: The most frequent causative organism in diabetic and non-diabetics is Pseudomonas 27.5% vs 27.1%, Staphylococcus 24.1% vs 27.1%, Klebsiella 24.1% vs 22.03%, E. coli 10.3% vs 10.16%, Proteus 5.17% vs 5.08%. No significant differences in resistance rates to Amikacin, Penicillin, Ofloxacin, Vancomycin, Piperacillin + Tazobactum were observed between diabetic and non-diabetic patients. There is significant difference in resistance to Ampicillin (p=0.017).Conclusions: Diabetes per se does not seem to influence the susceptibility pattern to antimicrobials in our group of patients with foot ulcer infections.

ADIE - Nursing Interventions of Diabetic Foot Ulcer: An Integrative Review of the Literature

2019 ◽  
Vol 16 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Sumarno Adi Subrata ◽  
Rutja Phuphaibul ◽  
Nirobol Kanogsunthornrat ◽  
Apinya Siripitayakunkit
Keyword(s):  
Diabetic Foot ◽  
Topical Therapy ◽  
Experimental Studies ◽  
Density Lipoprotein ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Integrative Review ◽  
Treatment Modalities ◽  
Nursing Interventions ◽  
Wound Fluid

Background and Aims: Diabetic foot ulcer is recognized as a consequence of peripheral neuropathy and peripheral arterial disease amid individuals with diabetes. As is well known, this situation still remains a crucial problem in nursing practice. Available studies describing an algorithm of inter- related nursing interventions concerned with diabetic foot ulcers are limited. Therefore, this integrative review was aimed to present evidence-based practice for overcoming the complications of diabetic foot ulcer as well as preventing lower extremity amputation. Methods: This integrative review retrieved scientific literature from PubMed, CINAHL, ProQuest, SAGE Publishing and ScienceDirect databases as published from 2008 to 2017. Thirty-seven studies that met the inclusion criteria were included in this study. Results: Our findings present that neurologic and circulatory assessments were considered as primary steps prior to conducting interventions. Formulating a diagnosis based upon the assessment results is a principal part to determine appropriate interventions. Multiple experimental studies displayed the effectiveness of certain interventions consist of applying wound cleansing, advanced modern wound dressing, topical therapy, offloading, intensive diabetes education and advanced treatment modalities. Hemoglobin A1c, high-density lipoprotein, procalcitonin, the potential of hydrogen of wound fluid, wound size, neurological and circulatory status were determined as the outcomes measurement which must be correctly evaluated. Conclusion: This review contributes an algorithm for intervening diabetic foot ulcer thereby generating the given name: ADIE (Assessment, Diagnosis, Interventions, and Evaluation). A collaborative care amid multidisciplinary diabetes team is needed for implementing along with evaluating the feasibility of the study findings. Moreover, active family participation also plays a crucial role to achieve successful management of diabetic foot ulcer at home.

scholarly journals Diabetic foot ulcer wound fluid: the effects of pH on DFU bacteria and infection

2015 ◽  
Vol 8 (S1) ◽  
Author(s):  
Carla McArdle ◽  
Katie Lagan ◽  
Sarah Spence ◽  
David McDowell
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Fluid ◽  
Effects Of Ph

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

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.

scholarly journals Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner’s Grades, IDSA/IWGDF Grades, and Ulcer Types

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Xiaoying Xie ◽  
Yunwen Bao ◽  
Lijia Ni ◽  
Dan Liu ◽  
Shaona Niu ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Diabetic Foot ◽  
Southern China ◽  
Foot Ulcer ◽  
Antibiotic Sensitivity ◽  
Diabetic Foot Ulcer ◽  
Resistance Pattern ◽  
Ischemic Ulcer ◽  
Resistance Patterns ◽  
Resistance Rates

Objective. To understand the bacterial profile and antibiotic resistance patterns in diabetic foot infection (DFI) in different Wagner’s grades, IDSA/IWGDF grades, and different ulcer types in Guangzhou, in order to provide more detailed suggestion to the clinician about the empirical antibiotic choice. Methods. 207 bacteria were collected from 117 DFIs in Sun Yat-sen Memorial Hospital from Jan.1, 2010, to Dec.31, 2015. The clinical data and microbial information were analyzed. Results. The proportion of Gram-negative bacteria (GNB) was higher than Gram-positive bacteria (GPB) (54.1% versus 45.9%), in which Enterobacteriaceae (73.2%) and Staphylococcus (65.2%) were predominant, respectively. With an increasing of Wagner’s grades and IDSA/IWGDF grades, the proportion of GNB bacterial infection, especially Pseudomonas, was increased. Neuro-ischemic ulcer (N-IFU) was more susceptible to GNB infection. Furthermore, with the aggravation of the wound and infection, the antibiotic resistance rates were obviously increased. GPB isolated in ischemic foot ulcer (IFU) showed more resistance than the N-IFU, while GNB isolates were on the opposite. Conclusions. Different bacterial profiles and antibiotic sensitivity were found in different DFU grades and types. Clinician should try to stay updated in antibiotic resistance pattern of common pathogens in their area. This paper provided them the detailed information in this region.

Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer

2018 ◽  
Vol 108 (6) ◽  
pp. 528-531 ◽  
Author(s):  
Andrew J. Hale ◽  
Emily Vicks ◽  
Mary T. LaSalvia ◽  
John M. Giurini ◽  
Adolf W. Karchmer
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The United States ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections

Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.

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