Are antibiotic-resistant pathogens more common in subsequent episodes of diabetic foot infection?

Lebowitz, Dan; Gariani, Karim; Kressmann, Benjamin; Dach, Elodie von; Huttner, Benedikt; Bartolone, Placido; Nam, Le Dinh; Mohamad, Morad; Lipsky, Benjamin A.; Uçkay, İlker

doi:10.1016/j.ijid.2017.04.012

Cited by 38 publications

(44 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fourthly, we defined remission as the absence of any clinical, radiological or laboratory signs of recurrent or new DFI at the site of prior infection, within one year following treatment of the prior DFI episode. In DFI, microbiological patterns of consecutive DFI episodes are only congruent in two‐thirds of cases at most, and new ischaemia, noncompliance, as well as inadequate anatomical positioning may lead to new infections at the same location. Hence, we overestimate the true risk of recurrence having more to do with patient's compliance or progressive ischaemia rather than with antibiotic effects.…”

Section: Discussionmentioning

confidence: 99%

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Rossel

Lebowitz

Gariani

et al. 2019

Endocrino Diabet & Metabol

Self Cite

View full text Add to dashboard Cite

Summary Objective The appropriate duration of antibiotic therapy for diabetic foot infections (DFI) after surgical amputations in toto is debated. There are discrepancies worldwide. Methods Using a clinical pathway for adult DFI patients (retrospective cohort analysis), we conducted a cluster‐controlled Cox regression analysis. Minimum follow‐up was 2 months. Results We followed 482 amputated DFI episodes for a median of 2.1 years after the index episode. The DFIs predominately affected the forefoot (n = 433; 90%). We diagnosed osteomyelitis in 239 cases (239/482; 50%). In total, 47 cases (10%) were complicated by bacteremia, 86 (18%) by abscesses and 139 (29%) presented with cellulitis. Surgical amputation involved the toes (n = 155), midfoot (280) and hindfoot (47). Overall, 178 cases (37%) required revascularization. After amputation, the median duration of antibiotic administration was 7 days (interquartile range, 1‐16 days). In 109 cases (25%), antibiotics were discontinued immediately after surgery. Overall, clinical failure occurred in 90 DFIs (17%), due to the same pathogens in only 38 cases. In multivariate analysis, neither duration of total postsurgical antibiotic administration (HR 1.0, 95% CI 0.99‐1.01) nor immediate postoperative discontinuation altered failure rate (HR 0.9, 0.5‐1.5). Conclusion According to our clinical pathway, we found no benefit in continuing postsurgical antibiotic administration in routine amputation for DFI. In the absence of residual infection (ie, resection at clear margins), antibiotics should be discontinued.

show abstract

Section: Discussionmentioning

confidence: 99%

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Rossel

Lebowitz

Gariani

et al. 2019

Endocrino Diabet & Metabol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lebowitz and co-workers followed 482 subjects for a median of 3.3 years after the first occurrence of diabetic foot infections and noted 2,257 total episodes of infection with a median of 7.6 months interval between recurrent episodes. 16 The causative pathogens was noted to be the same as in previous episodes in 43% of recurrent cases with no significant increase in the incidence of antibiotic resistance over the episodes. 16 The authors concluded that previous diabetic foot infection episodes did not predict a greater likelihood of antibiotic-resistant isolate in subsequent episodes, and broadening the spectrum of empiric antibiotic therapy for recurrent episodes of diabetic foot infections did not appear necessary.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 67%

“…16 The causative pathogens was noted to be the same as in previous episodes in 43% of recurrent cases with no significant increase in the incidence of antibiotic resistance over the episodes. 16 The authors concluded that previous diabetic foot infection episodes did not predict a greater likelihood of antibiotic-resistant isolate in subsequent episodes, and broadening the spectrum of empiric antibiotic therapy for recurrent episodes of diabetic foot infections did not appear necessary. 16 Needless to say, larger studies are needed to confirm or refute these findings.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 67%

Diagnosis and treatment of diabetic foot osteomyelitis

Fujii

Terashi

2015

J Jpn Soc Limb Salvage Podiatr Med

View full text Add to dashboard Cite

osteomyelitis with a specific focus on advanced imaging modalities in terms of current evidence as well as emerging technological advances. Treatment Surgical resection of infected bone and tissues is typically the traditional approach for diabetic foot infection and osteomyelitis. 7 Surgery is rapidly effective in reducing the bacterial load at the infected site and can remove necrotic tissues that cannot be reached by antibiotics; however, this procedure is extremely invasive, leaves the patient's foot disfigured, and can potentially introduce new bacteria to the wound. 12 Moreover, recurrence of diabetic foot osteomyelitis has been noted in about 20% to 50% of the cases despite the use of surgical debridement and long-term antibiotic therapy. 11,13 In the modern management of diabetic foot osteomyelitis that was published in January of this year, key opinion leaders in infectious disease recommended that "Antibiotic therapy, preferably with oral agents guided by results of bone culture, for a duration of no more than 6 weeks,

show abstract

“…Staphylococcus aureus is consistently the most prevalent species (>50% of all wounds), followed by coagulase‐negative Staphylococci spp. and Streptococcus spp . S. aureus , including methicillin‐resistant S. aureus (MRSA), is often found in association with other Gram‐positive pathogens and mixed anaerobic communities, but not Pseudomonas aeruginosa , a common misconception .…”

Section: Culture‐based Characterization Of Chronic Wound Microbiomesmentioning

confidence: 99%

“…and Streptococcus spp. [47][48][49][50] S. aureus, including methicillin-resistant S. aureus (MRSA), is often found in association with other Grampositive pathogens and mixed anaerobic communities, but not Pseudomonas aeruginosa, a common misconception. [51][52][53] Because of P. aeruginosa's ability to form the archetypal mushroom-like biofilm colonies encapsulated in a protective extracellular matrix in vitro, it has been studied as a model organism of biofilm formation.…”

Section: Culture-based Characterization Of Chronic Wound Microbiomesmentioning

confidence: 99%

The role of the microbiome in nonhealing diabetic wounds

Kalan

Brennan

2018

Annals of the New York Academy of Sciences

105

View full text Add to dashboard Cite

Wound healing is a highly coordinated and complex process, and there can be devastating consequences if it is interrupted. It is believed that, in combination with host factors, microorganisms in a wound bed can not only impair wound healing but can lead to stalled, chronic wounds. It is hypothesized that the wound microbiota persists in chronic wounds as a biofilm, recalcitrant to antibiotic and mechanical intervention. Cultivation-based methods are the gold standard for identification of pathogens residing in wounds. However, these methods are biased against fastidious organisms, and do not capture the full extent of microbial diversity in chronic wounds. Thus, the link between specific microbes and impaired healing remains tenuous. This is partially because local infection and, more specifically, the formation of a biofilm, is difficult to diagnose. This has led to research efforts aimed at understanding if biofilm formation delays healing and leads to persistent and chronic infection. Circumventing challenges associated with culture-based estimations, advances in high-throughput sequencing analysis has revealed that chronic wounds are host to complex, diverse microbiomes comprising multiple species of bacteria and fungi. Here, we discuss how the use of genomic methodologies to study wound microbiomes has advanced the current understanding of infection and biofilm formation in chronic wounds.

show abstract

Are antibiotic-resistant pathogens more common in subsequent episodes of diabetic foot infection?

Cited by 38 publications

References 16 publications

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

Diagnosis and treatment of diabetic foot osteomyelitis

The role of the microbiome in nonhealing diabetic wounds

Contact Info

Product

Resources

About