Efficacy of Femoral Intra-arterial Administration of Teicoplanin in Gram-Positive Diabetic Foot Infections

Abstract

In this study the efficacy and safety femoral intra-arterial administration of teicoplanin in the treatment of diabetic foot infections caused by gram-positive bacteria were evaluated. Twenty-five hospitalized diabetic patients with foot ulcers or with foot ulcers and metatarsophalangeal osteomyelitis were included in the study. In the ulcers Staphylococcus aureus was present alone in 16 patients and was associated with Pseudomonas aeruginosa in 2 patients, with Candida albicans in 2, and with coagulase-negative Staphylococcus in 1 patient. In 4 patients other gram-positive bacteria were isolated. All isolated strains were resistant to various antibiotics tested. Teicoplanin, 200 mg, was administered once a day by femoral intra-arterial injection for an average period of 14.72 +/- 7.16 days (range ten to thirty-six days). Six patients were treated with an additional antibiotic intramuscularly or intravenously because of a mixed infection. At the end of the therapy microbiological assessment confirmed that gram-positive infection was eliminated in all patients. Clinical outcome demonstrated that healing occurred in 18 patients (72%) and improvement in 7 patients (28%). No adverse drug reactions were observed during the treatment. The results demonstrate that femoral intra-arterial administration of teicoplanin was highly effective in skin- and bone-infected lesions in the diabetic foot. This method may represent a further advantage in management of this severe diabetic complication.

Gangrenous necrosis of the diabetic foot caused byFusarium acutatum

“…In the majority of reported cases, diabetic foot infections are polymicrobial in nature [26]. The fungi isolated from diabetic foot are almost always superficially pathogenic when found in skin or nail scraping; such infections are predominately caused by Trichophyton rubrum, Trichophyton metagrophytes, Scytalidium dimidiatum , Candida, and Fusarium species [9,10,12]. F. solani is reported as the etiological agent of infected leg ulcers in a diabetic patient [27], and in severe infections, it may progress to cause osteomyelitis of the diabetic foot [13].…”

“…Mycotic infections of the diabetic foot are generally classified into two categories; those that cause superficial infections, skin and onychomycosis [6 Á10], and the fungi that infect tissue causing severe ulceration and serious complications by progressing deep into tissue, which may result in osteomyelitis. The fungi involved in the later syndrome are mainly Candida species [11,12] or Fusarium solani [13]. Fusarium is one of the most important emerging pathogenic fungi [14,15].…”

Expert opinion on the management of infections in the diabetic foot

“…Problems with limb arterial insufficiency have led some to experiment with novel methods of antibiotic delivery to the lower limb, for example retrograde intravenous perfusion under pressure , intra‐arterial (e.g. femoral) administration or primary closure of debrided wounds with catheter instillation of antibiotics . These techniques have not yet proven their usefulness.…”

A report from the international consensus on diagnosing and treating the infected diabetic foot

“…Problems with limb arterial insufficiency have led to experiments with novel methods of limb antibiotic delivery, for example, retrograde intravenous perfusion under pressure [35,36], intra-arterial (e.g. femoral) administration [37], or primary closure of debrided wounds with catheter instillation of antibiotics [38]. These techniques require further study.…”