Diabetic foot infection in hospitalized adults

Katz, David; Friedman, N. Deborah; Ostrovski, Evgenia; Ravid, Dor; Amrami, Nadav; Avivi, Dori; Mengesha, Bethlehem; Lazarovitch, Tsilia; Dadon, Mor; Marchaim, Dror

doi:10.1016/j.jiac.2015.12.007

Cited by 25 publications

(27 citation statements)

References 28 publications

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“…Rates of MRSA in Lebanon (3.3% of all isolates) are significantly lower than in Western countries where some studies found MRSA in 32% of all diabetic foot infections [2,11]. A study done in Israel found MRSA in only 3% of diabetic foot ulcer infections [12]. Therefore, since S. aureus does not constitute one of the most common pathogens isolated from diabetic foot ulcers in our study, MRSA coverage should only be considered for patients with high risk of acquiring the bacteria.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

Obeid

Moughames

Aboulhosn

et al. 2018

J Infect Dev Ctries

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Introduction: Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. Global studies on the epidemiology of diabetic foot ulcer (DFU) infections and guidelines detailing the most common pathogens and their respective antimicrobial susceptibilities are available. While Gram-positive cocci, mainly Staphylococcus species (spp.), were the most common organisms cultured from DFU in the United States, the Gram-negative Pseudomonas spp. were found to be the most common in some Middle Eastern countries. In Lebanon, however, such studies remain scarce. This study, conducted in Lebanon, investigated the most common organisms in DFU infections and their antimicrobial profiles. Methodology: We collected data from all documented diabetic foot infections between January 2015 and March 2016, 128 participants total, from 5 different hospitals in various regions of Lebanon. Results: Among all isolates, Enterobacteriaceae (42%), Pseudomonas spp. (18.6%) and methicillin-sensitive Staphylococcus aureus (MSSA) (15.3%) were the most frequent bacteria. In addition, 72% of Pseudomonas spp. were susceptible to ciprofloxacin and 63.6% of Enterobacteriaceae were susceptible to either amoxicillin/clavulanate or ciprofloxacin, 91% were susceptible to piperacillin/tazobactam. Methicillin-resistant Staphylococcus aureus (MRSA) was only found in hospitalized patients or those who received prior antibiotics. Polymicrobial infections were documented in only 38% of patients. Conclusion: In Lebanon, the most appropriate empirical oral outpatient treatment would be a combination of amoxicillin/clavulanate and ciprofloxacin. As for admitted patients who have failed the oral regimen, piperacillin/tazobactam would then be the treatment of choice.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

Obeid

Moughames

Aboulhosn

et al. 2018

J Infect Dev Ctries

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“…The prevalence of methicillin-resistant S. aureus (MRSA) in DFI varies among countries with an exacerbation in countries that are less developed ( Figure 2 ) [ 19 , 20 , 28 , 29 , 30 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. MRSA are more often isolated from patients who have been previously hospitalized or reside in a chronic care facility, who have recently received antibiotic therapy or who have had a previous amputation [ 41 , 74 ].…”

Section: Dfi and Staphylococcus Aureusmentioning

confidence: 99%

Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis

Dunyach-Rémy

Essebe

Sotto

et al. 2016

Toxins

130

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Infection of foot ulcers is a common, often severe and costly complication in diabetes. Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated. The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI. The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection. Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes) and non-toxinogenic strains. Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis. Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds.

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“…Streptococcus are usually <2 µm in diameter, ovoid or spheroidal in appearance and has a chain-like appearance. They have a strong invasiveness and can produce a variety of exotoxins, which can aggravate the degree of infection in patients (12). Enterococcus are a group of intestine-dwelling bacteria in the shape of oval or spherical.…”

Section: Discussionmentioning

confidence: 99%

Bacterial distribution, changes of drug susceptibility and clinical characteristics in patients with diabetic foot infection

Liu

et al. 2018

Exp Ther Med

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The present study aimed to investigate the bacterial distribution, changes in drug susceptibility and clinical characteristics in patients with diabetic foot infection (DFI). A retrospective analysis of 216 patients with DFI treated at Xinxiang Central Hospital between 2013 and 2016 was carried out to analyze the bacterial distribution, changes of susceptibility and clinical characteristics. A total of 262 pathogenic strains were isolated from 216 patients with DFI. Among them, 43.13% exhibited Gram-positive (G+) bacteria, 45.04% exhibited Gram-negative (G−) bacteria and 11.83% was other. Between 2013 and 2016, the susceptibility of pathogenic bacteria to common antibacterial drugs showed a declining trend year by year. G+ bacteria had high susceptibility to vancomycin and acetazolamide; while G− bacteria showed high susceptibility to dibekacin, panipenem and biapenem. The main clinical symptoms of the 216 patients included edema (98.61%), purulent secretions (62.96%) and lower extremity sepsis (58.80%). The top three complications of the 216 cases were lower extremity vascular disease (58.80%), peripheral neuropathy (39.81%) and kidney disease (26.39%). Logistic regression analysis showed that age [odds ratio (OR), 2.708; P=0.005], previous use of antibacterial drugs (OR, 3.816; P=0.007) and application of the third generation cephalosporins (OR, 3.014; P=0.008) were the independent risk factors of drug resistance in patients with DFI (P<0.05). There were numerous types of pathogens in patients with DFI, and all of them had certain drug resistance. The drug susceptibility was decreasing year by year. The pathogens and drug resistance in patients with DFI should be monitored to reduce the incidence of related complications and improve the prognosis of patients.

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Diabetic foot infection in hospitalized adults

Cited by 25 publications

References 28 publications

Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

Epidemiology and susceptibility profiles of diabetic foot infections in five hospitals in Lebanon

Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis

Bacterial distribution, changes of drug susceptibility and clinical characteristics in patients with diabetic foot infection

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