Etiological Factors of Infections in Diabetic Foot Syndrome – Attempt to Define Optimal Empirical Therapy

Abstract

Background. Diabetic foot syndrome (DFS) represents one of the most frequent reasons for lower limb amputation in developed countries. In most cases, it is associated with bacterial infection, requiring optimal antibiotic therapy. Objectives. The aim of this study was to identify the most frequent pathogens responsible for infections associated with DFS, establish the optimal protocol of empirical therapy, and ascertain the clinical variables that may determine the choice of the appropriate antibacterial agent. Material and Methods. The analysis included hospital records of patients treated at the Department between 2008 and 2010. A total of 102 individuals were identified; their material was cultured and tested for antibiotic susceptibility. Results. A total of 199 bacterial strains were isolated. There was a predominance of Gram-positive bacteria, particularly Staphylococcus aureus, Staphylococcus coagulase-negative strains, and Enterococcus faecalis. Of note was the high percentage of E. faecalis infection (16.08%). One can speculate on the potential etiological factors in the case of some bacteria, e.g. patients infected with S. aureus were characterized by higher monocytosis and lymphocytosis as compared to other patients. Analysis of drug susceptibility revealed that ciprofloxacin has the highest (but still only 44%) efficacy of all agents tested as monotherapy, and a combination of piperacillin and tazobactam or amoxicillin and clavulanate with aminoglycosides is particularly beneficial. Conclusions. Staphylococcus spp. predominates amongst the etiological factors of DFS infection; however, the rate of E. faecalis infection is alarmingly high. Monotherapy enables effective treatment in a minority of cases; therefore, at least two-drug protocols should be implemented from the very beginning of the therapy (Adv Clin Exp Med 2014, 23, 1, 39-48).

Different Patterns of Bacterial Species and Antibiotic Susceptibility in Diabetic Foot Syndrome with and without Coexistent Ischemia

“…As in our previous study [7], Gram-positive and Gramnegative strains were isolated with almost the same frequency. It is considered that infections with Gram-positive bacteria are more common in Western communities, whilst Gram-negative bacteria are more common in Eastern communities [8].…”

THE ROLE OF STAPHYLOCOCCUS AUREUSIN THE CLINICAL DIAGNOSIS OF DIABETIC PATIENTS

“…However, out of all the etiological factors Staphylococcus spp. was 26.63%, which in particular consists of coagulase-positive S. aureus isolated in most cases of DFU [31]. The study suggests that Staphylococcus spp.…”

“…Diabetic foot syndrome (DFS) is one of the most common causes of lower extremity amputation in developed countries [31]. DFS is defined as ulcer or destruction of deep tissues of the foot in patients with diabetes, with the presence of neurological disorders and peripheral vascular disease of the lower limbs at different levels.…”

Phototherapy in the Treatment of Diabetic Foot — A Preliminary Study

“…In the latter case, the infection, usually of a multibacterial nature, spreads rapidly and improper management of the wound healing process leads to the formation of deep ulcers, as well as weakening of bones and joints. Approximately 15-25% of diabetics develop foot ulcers and DFS and the risk of limb amputation in diabetic patients is several times higher than in subjects without the condition [1][2][3][4][5][6]. Sample photographs of diabetic foot are presented in Figure 1.…”

“…However, this is not always suffi cient, in some cases, it is necessary to use appropriate dressings, antibiotic therapy, and sometimes also to remove necrotic tissue. It is estimated that up to 15% of patients may undergo a limb amputation at some stage in their lives [1][2][3][4][5][6]. Since conventional treatment of chronic wounds often fails, additional methods such as vacuum dressings, hyperbaric oxygen therapy, topical use of carbon dioxide, and other methods are used in daily practice [1][2][3][4][5][6][7][8].…”