A Retrospective Analysis of Microbiologic Profile of Foot Infections in Patients With Diabetic End-Stage Renal Disease

Abstract

Objective Individuals with diabetes and end-stage renal disease (ESRD) are at increased risk of foot ulceration and lower extremity amputation. Although risk factors and microbiologic analysis of diabetic foot infections ( DFIs) have been extensively studied, there are limited data available for this characteristic group. Methods Clinical, demographic, laboratory, microbiological data, and foot examination information were collected retrospectively regarding 94 patients with ESRD who were referred for DFI between 2006 and 2016 to hyperbaric oxygen therapy. Results In 6 of 94 patients with ESRD (mean age 60 years; 65 males [69.1%], 29 women [30.8%]; 91 undergoing hemodialysis [96.8%], one peritoneal dialysis [1%], two [2%] recent renal transplants), the lesions were bilateral; therefore, the evaluations were made over 100 DFIs. The most common pathogens isolated in deep wound cultures were Staphylococcus aureus and Pseudomonas aeruginosa, respectively, contributing to 27 (21.2%) and 16 (12.5%) of all 127 isolates. When the distribution of the isolates according to different Wagner grades were analyzed, it was found that the proportion of Gramnegative isolates increased statistically significantly with the ascending Wagner grade (P = .004). Conclusion DFIs indicate a serious complication associated with a high risk of amputation, prolonged antibiotic treatment, increased hospital and procedure demands, and the cost of health care, on patients with ESRD. The familiarization of causative pathogens underlying DFIs can aid the clinicians in the choice of appropriate empirical antibiotic treatment. This study emphasizes the need for greater attention to risk factors and the microbiologic profile of DFIs in this characteristic group.

Extensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with ceftazidime/avibactam and ceftolozane/tazobactam in a tertiary care university hospital center in Portugal – A cross-sectional and retrospective observational study

“…While P. aeruginosa is rarely found in the microbiota of healthy humans ( Silby et al, 2011 ; Estepa et al, 2014 ), it can colonize up to 80% of patients with risk factors, such as a large exposure to the healthcare setting or certain chronic illnesses (such as cystic fibrosis, and solid or hematologic malignancies) ( Gómez-Zorrilla et al, 2014 ; Ciofu et al, 2015 ). The presence of foreign devices, such as venous or urinary catheters, tracheostomy (especially in children), open abdominal surgery, diabetes, chronic hepatic disorder and end-stage renal disease also increase the risk for P. aeruginosa infection ( Varaiya et al, 2008 ; Willmann et al, 2014 ; Miller et al, 2016 ; Bassetti et al, 2018a ; Russell et al, 2019 ; Jean et al, 2020 ; Körpinar, 2021 ). Also prior antibiotic therapy (especially fluoroquinolones and carbapenems), so frequent in the healthcare setting and in patients with these comorbidities, is a major risk factor for attaining MDR strains ( Falagas et al, 2006 ; Peña et al, 2012 ; Gómez-Zorrilla et al, 2014 ; Bassetti et al, 2018a ; Jean et al, 2020 ).…”

Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review

“…This aligns with our finding that more than one foot or lower limb health outcome (PAD, foot ulceration, amputation, related infection, and associated hospital admission) was reported in 67% of identified studies ( n = 141). As noted previously, often more than one foot or lower limb health complication is experienced by adults undergoing dialysis [4] and these complications are frequently interrelated [3]. As such, an interdisciplinary approach to both research and care is essential.…”

“…34% of ulcers precede amputation) [4] and these complications are often interrelated (e.g. more complex foot ulcers are associated with more complex infections) [3].…”

“…A previous study among 450 dialysis patients in Australia identified the prevalence of PAD at 52%, current foot ulceration at 10% and previous amputation (minor or major) at 10% [1]. Infection susceptibility is higher for patients with renal disease [2, 3], and 33% of hospital admissions over a 30‐month follow‐up period among 150 dialysis patients in the United States of America were related to foot health [4]. Of added complexity, more than one foot or lower limb health complication is often experienced by dialysis patients (e.g.…”

Sweet Readers Love the Spring

“…Thanganadar Appapalam and colleagues 1 have revisited multi-drug resistant bacteria in diabetic foot ulcers. In a similar context, Körpinar 2 has carried out a retrospective enquiry into bacterial isolates of diabetic foot infections in end-stage renal disease. Pincelli and colleagues 3 describe the clinical picture and hallmarks of Livedo racemosa.…”