Changing Bacterial Etiology and Antimicrobial Resistance Profiles as Prognostic Determinants of Diabetic Foot Infections: A Ten-Year Retrospective Cohort Study

Sürme, Serkan; Kurt, Ahmet; Karaali, Rıdvan; Balkan, İ̇lker İnanç; Bağhaki, Semih; Caglar, Bilge; Özdemir, Meryem; Vatan, Aslı; Togluk-Yigitoglu, Eylem; Budak, Beyhan; Arapi, Berk; Şeker, Ali; Can, Günay; Çetinkale, Oğuz; Gonen, Mustafa Sait; Saltoğlu, Neşe

doi:10.1089/sur.2022.150

Cited by 7 publications

(8 citation statements)

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“…The lack of diagnostic microbiological cultures may lead to an over use of (not necessary) antibiotic agents, even if it is for a short period of time. New data from some resource‐poor settings suggest an increase in the proportion of multidrug‐resistant (MDR) Gram‐negatives in community‐acquired DFIs, of which the biggest burden would be due an increase in Pseudomonas aeruginosa [ 1 , 5 , 15 , 16 , 17 , 18 ]. In settings with a high prevalence of (quinolone‐resistant) [ 18 ] Pseudomonas spp., clinicians might tend to cover Pseudomonas , and other nonfermenting rods, from the start with broad‐spectrum parenteral antibiotics (maybe even as a combination therapy) [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Recent Turkish literature [ 17 ], and articles from the Southern Mediterranean [ 17 , 22 , 23 ], Asia [ 24 ] and (Sub)‐Saharan Africa [ 25 , 26 , 27 , 28 , 29 , 30 ], indicate a high prevalence of P. aeruginosa , for which the reasons remain unknow. Several African studies from specialised diabetes centres and hospitals report a >60% resistance to third generation cephalosporins and an increasing resistance towards carbapenems among both, the Gram‐negative and Gram‐positive bacteria [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], whereas in Asia, the microorganisms classified as MDR seem to shift towards more Gram‐negative bacteria [ 17 ]. Unsurprisingly, MDRs in DFI might contribute to a worse clinical prognosis when compared to their susceptible bacterial counterparts [ 17 , 23 , 24 , 25 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries

Abbas,

Gangji,

Uçkay

2024

Endocrino Diabet & Metabol

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BackgroundDiabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI).MethodsWe evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource‐poor settings such as in Africa.ResultsThe management of DFI very often is adapted to the financial and practical realities of the resource‐poor regions. The application of the point‐of‐care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi‐quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs.ConclusionsIn the practical and resource‐saving management of DFI, the ‘therapeutic’ use of Gram stains is not common in resource‐rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries

Abbas,

Gangji,

Uçkay

2024

Endocrino Diabet & Metabol

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“…Diyabetik ayak infeksiyonlarında dirençli patojen varlığı; tedavi başarısızlığı, uzamış hastane yatışları ve maliyet artışı ile doğrudan ilişkili bulunmuştur (12). 2010 yılı sonrasında Türkiye' de yapılmış çok merkezli çalışmalarda S. aureus suşlarında metisilin direnci %20-31, Enterobacteriaceae ailesi içinde genişlemiş spektrumlu β-laktamaz (GSBL) pozitifliği %27-38.5, P. aeruginosa' da çoğul ilaç direnci (ÇİD) pozitifliği %18-21 olarak saptanmıştır (15,19,22).…”

Section: Soru 2: Hangi Durumlarda Dirençli Patojenler Düşünülmelidir?unclassified

“…Önceden kolonizasyonu olan hastalarda yaraya yeterince nüfuz edemeyen antibiyotiklerin kullanılması da bu bakterilerle infeksiyon gelişmesine neden olabilmektedir (71). Diyabetik ayak infeksiyonu sürveyansı ile çoğul ilaç dirençli baktreiler (GSBL oluşturan bakteriler, Acinetobacter gibi) tespit edilmeli, kolonize-infekte ayrımı yapıldıktan sonra, antibiyograma uygun tedavi açısından hasta değerlendirilmelidir (22,72).…”

Section: Soru 5: Diyabetik Ayak İnfeksiyonlarının Ampirik Tedavisind...unclassified

“…Son yıllarda yapılan çalışmalarda, diyabetik ayak infeksiyonları kapsamında ÇİD olan etkenlerde artış görüldüğü bildirilmiştir. Sıklıkla şiddetli infeksiyonu, polimikrobiyal üremesi ve hastaneye yatış öyküsü olan hastalardan çoğul ilaç dirençli bakteriler izole edilmektedir (18,22,94). Bu bakteriler, aynı ayaktaki yara için daha önce hastaneye yatış öyküsü olan hastaların 1/3'ünde, osteomyeliti olan hastaların ise 1/4'ünden izole edilir.…”

Section: Soru 7: çOğul İlaç Dirençli Bakteri İnfeksiyonları Nasıl T...unclassified

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Untitled

2024

Klimik Derg

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Surgical management of DF ulcers can be analyzed in five sections: (a) Urgent ulcer intervention; abscess drainage and/or debridement, (b) surgical interventions for vascular pathologies, (c) ulcer closure interventions; reconstruction methods; graft and flap surgery, (d) reconstruction of bone and foot pathologies for ulcer prevention and treatment (Charcot foot deformity, Achilles lengthening, tenotomy, and osteotomies, etc.), (e) minor and major amputations when necessary. 14) Amputation may be a more appropriate choice when infected tissue cannot be completely cleaned with debridement, when the patient is bedridden or has a non-functional extremity, when it is believed that adequate revascularization cannot be achieved by orthopedic and plastic surgical interventions, in cases where reconstruction is nearly impossible, and in dialysis patients. 15) The goal of post-DFI reconstruction is to allow the ankle to reach a neutral position and to make the plantar surface of the foot have a balanced contact with the ground. 16) Selected ulcer care products can be used based on the characteristics of the ulcer to support and accelerate ulcer healing, reduce the risk of complications, ensure patient comfort during treatment, and improve quality of life. 17) DF ulcers often develop due to improper shoe selection during the structural and biomechanical changes, resulting in fluid accumulation and callus formation around bone surfaces. 18) Orthoses, which distribute pressure over the widest possible area, are the most effective means of reducing plantar pressure in the foot. 19) Hyperbaric oxygen therapy is beneficial in addition to revascularization and antibiotic therapy, which are the primary treatments for pathologies causing tissue hypoxia, such as ischemia, infection, and edema. 20) Negative pressure ulcer therapy is an additional adjunct method to conventional techniques, and it can contribute to the healing process with the correct indications. 21) In cases where the infection is under control, active osteomyelitis is absent, topical epidermal growth factor (EGF) can be used for Meggitt-Wagner ulcer classification grade 1-3, and intralesional EGF applications can be used for grade 3-4 in addition to standard treatments. 22) Preventive medical practices in people with diabetes, collaborative efforts of the patients, their families, and the medical team, and regular patient education are necessary to prevent DF ulcer development. In the event of DF ulcer development, interdisciplinary collaboration in moderate/severe infections is essential for early treatment and infection prevention.

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