Diabetic Foot Infections: Local Prevalence of and Case–Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa

Kim, Justin; Lydecker, Alison D.; Dave, Rohini; Bork, Jacqueline T.; Roghmann, Mary-Claire

doi:10.1093/ofid/ofaa412

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…Overall, S. aureus was present in 40% of all positive samples, and 12.5% of culture‐positive samples yielded MRSA. These finding are concordant with previous studies, which identify S. aureus as the most common pathogen in diabetic foot infection and osteomyelitis in Western countries 22,23 . Parks et al described similar findings in a Veterans Affairs cohort where S. aureus was identified in 49.4% of positive bone cultures with MRSA identified in 17.4% of positive samples.…”

Section: Discussionsupporting

confidence: 91%

Is fluoroscopy‐guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study

Al‐Balas

Metwalli

Nagaraj

et al. 2023

Journal of Diabetes

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Background Diabetic foot infection, particularly osteomyelitis, is a major risk factor of amputation in persons with diabetes. Bone biopsy with microbial examination is considered the gold standard of diagnosis of osteomyelitis, providing information about the offending pathogens as well as their antibiotics susceptibility. This allows targeting of these pathogens with narrow spectrum antibiotics, potentially reducing emergence of antimicrobial resistance. Percutaneous fluoroscopy guided bone biopsy allows accurate and safe targeting of the affected bone. Methods In a single tertiary medical institution and over 9 year period, we performed 170 percutaneous bone biopsies. We retrosepctively reviewed the medical record of these patients including patients' demographics, imaging and biopsy microbiology and pathollogic results. Results Microbiological cultures of 80 samples (47.1%) were positive with 53.8% of the positive culture showed monomicrobial growth and the remaining were polymicrobial. Of the positive bone samples 71.3% grew Gram‐positive bacteria. Staphylococcus aureus was the most frequently isolated pathogen from positive bone cultures with almost one third showing methicillin resistence. Enterococcus species were the most frequently isolated pathogens from polymicrobial samples. Enterobacteriaceae species were the most common Gram‐negative pathogens and were more common in polymicrobial samples. Conclusions Percutaneous image‐guided bone biopsy is a low‐risk, minimally invasive procedure that can provide valuable information about microbial pathogens and therefore enable targeting these pathogens with narrow spectrum antibiotics.

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Section: Discussionsupporting

confidence: 91%

Is fluoroscopy‐guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study

Al‐Balas

Metwalli

Nagaraj

et al. 2023

Journal of Diabetes

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“…Limited information exists on coagulasenegative Staphylococci methicillin resistance, but our survey indicated a signi cant rate (66.7%). This rate remained below that of a middle-income country (91.8%) [18], exceeding that of another highincome country (55.4%) [30], and that of a national survey (27.2%) [5]. Enterococcus spp.…”

Section: Discussionmentioning

confidence: 93%

Microbiological Characterization of Neuropathic Diabetic Foot Infection: a Retrospective Study at a Portuguese Tertiary Hospital

Gonçalves,

Guimarães,

Ferreira

et al. 2024

Preprint

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Diabetic foot infection imposes a significant burden and is the major cause of nontraumatic limb amputation. Adequate patient management with effective antibiotic therapy is crucial. This retrospective cohort study aimed to characterize the microbiology and resistance patterns of moderate to severe neuropathic diabetic foot infection in patients hospitalized at a tertiary referral hospital between January 2020 and June 2023. Deep tissue specimens from ulcers were collected for culture. Sixty inpatients were included (62% male, mean age 59.1 ± 11.5 years). Osteomyelitis was present in 90% of the patients. Among 102 microorganisms (average of 1.91 ± 1.25 pathogens per patient), 60.8% were gram-positive bacteria, 31.4% were gram-negative, 3.92% were anaerobic bacteria, and 3.92% were fungi. Staphylococcus aureus (19%) and Enterococcus faecium (17%) were the most common. Pseudomonas aeruginosa (8%) and bacteria of the Enterobacterales family (24%) accounted for all the isolated gram-negative bacteria. Sixteen percent of Staphylococcus aureus and 67% of coagulase-negative Staphylococci were resistant to methicillin. Resistance to ampicillin was found in 11% of Enterococci. All Pseudomonas aeruginosa isolates were sensitive to piperacillin-tazobactam, ceftazidime, or cefepime. Among the Enterobacterales, resistance rates were 35% for piperacillin-tazobactam, 35% for ceftazidime, 17% for cefepime, and 13% for carbapenems. Although the prevalence of methicillin-resistant staphylococci was lower than that in other studies, carbapenem resistance among gram-negative bacteria warrants attention. This study highlights the importance of understanding local epidemiology for effective diabetic foot infection management and resistance mitigation.

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“…MDR bacterial infection was defined based on pathogen resistance to three or more different types of antibiotics. 20 DFI also termed as lower extremity infection, or referring to infection in the area below the ankle (excluding the ankle). 21 Diabetic patients with DFU and DFI were graded from 0 – five according to the reference.…”

Section: Methodsmentioning

confidence: 99%

Clinical and microbiological profile of bacterial pathogens from patients with diabetic foot infections at a teaching hospital in the northeast China

Meng

et al. 2022

Eur J Inflamm

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Background: Diabetic foot ulcer infection (DFI) is a frequent complication of diabetes. Objective: The aim is to determine the clinical and microbiological profiles and the antibiotic resistance phenotype, analyze the DFIs risk factors. Methods: The present study is a retrospective, single-center study conducted at a teaching hospital in the northeast China. 242 cases of patients with diabetic foot disease Wagner grade 0–5 over 2 years were screened and the recovered data consisted of the clinical features, risk factors, etiology and drug resistant profiles. Results: The total percentage of Gram-negative rods (GNRs) and Gram-positive cocci (GPCs) was 138 (54.92%) and 113 (45.02%). The most common isolates were Pseudomonas aeruginosa and Staphylococcus aureus, accounting for 22.37% and 19.74%, respectively. Logistic regression analysis showed that the duration of ulcer, duration of antibiotic use, Wagner classification and osteomyelitis were risk factors for multi-drug resistant (MDR) bacteria infection ( p<0.05). Conclusion: The predominate pathogens of patients with DFI were GNRs, followed by GPCs in the region. They exhibited the different antibiotic resistance phenotype. The data provided advice on selection of highly sensitive antibiotics in the management of DFIs.

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Diabetic Foot Infections: Local Prevalence of and Case–Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa

Cited by 9 publications

References 11 publications

Is fluoroscopy‐guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study

Is fluoroscopy‐guided percutaneous bone biopsy of diabetic foot with suspected osteomyelitis worthwhile? A retrospective study

Microbiological Characterization of Neuropathic Diabetic Foot Infection: a Retrospective Study at a Portuguese Tertiary Hospital

Clinical and microbiological profile of bacterial pathogens from patients with diabetic foot infections at a teaching hospital in the northeast China

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