Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients

Chander, Jagdish; Gupta, Varsha; Mohi, Gursimran Kaur; Attri, Ashok Kumar

doi:10.4103/jlp.jlp_106_18

Cited by 18 publications

(21 citation statements)

References 10 publications

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“…This came along with other studies conclusions where it was found that no single antibiotic used empirically offers adequate coverage for all potential bacteria found in diabetic foot ulcers [27]. In addition to that, poor penetration of antibiotics into the lower limb tissue due to peripheral arterial disease makes therapy less effective [28].…”

Section: Discussionsupporting

confidence: 58%

Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate

Shaheen

Dahab

Fada

et al. 2021

Int J Diabetes Dev Ctries

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Background Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus with devastating outcomes. Poorly treated DFU leads to osteomyelitis, gangrene and limb amputation. There is an increased risk of mortality for the amputees and increased number of bacterial resistance in survived patients. Struggle on choice of the best antibiotic(s) for DFU is escalating. Objectives To determine risk factors associated with mortality in patients with DFU. To investigate bacterial drug resistance in survived or deceased patients around amputation. Methodology This is a retrospective cohort study that involved all diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020. Antibiotic use and bacterial isolates along with culture and sensitivity test results were retrieved from patients' profiles and laboratory records. Major outcome of study was survival rate around amputation. Patients who missed test results for FBS or HbAc1, or who had no wound culture were excluded. SPSS version 22 was used to analyze data. Results Eighty four subjects were included in this study, 64.8 ± 12.58 years old, 63.1% males who had diabetic foot ulcer, minor or major limb amputation between 2013 and 2020 at Hebron Governmental Hospital. Forty tow patients (50%) had diabetic foot ulcer, 28 patients (33.3%) had major limb amputation, and 14 patients (16.7%), succumbed to minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 ± 1.89%. Mortality rate was 9.5%. Using the Chi square test, we found a significant relationship between mortality and type of isolated bacteria, p = 0.033 and between diabetic complications (nephropathy) and mortality, p = 0.033. There was a significant relationship between antibiotic use and mortality, p = 0.04, especially with metronidazole and colistin, if they were used around limb amputation. Conclusions Mortality of diabetic patients with DFU was associated with nephropathy and Acinetobacter or E. coli infections.

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Section: Discussionsupporting

confidence: 58%

Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate

Shaheen

Dahab

Fada

et al. 2021

Int J Diabetes Dev Ctries

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“…MDR organisms are predominantly isolated from wounds of diabetic foot patients compared to non-diabetic patients, which lead to the failure of empirical treatments and increased mortality and morbidity (28). A very high rate of antibiotic resistance was observed in this study, this result agrees with Datta et al (29) and Pal et al (30) results. The treatment of choice remains carbapenem or a combination of beta-lactam/ beta-lactamase inhibitors as mentioned elsewhere (31); however, in this study, resistance to these antibiotics was observed, with 22.2% of the microorganisms being resistant to imipenem and 16.6% being resistant to ertapenem (both are related to the carbapenem group); 55.5% were resistant to ampicillin/sulbactam, 44.4% to amoxicillin/clavulanic acid, and 16.6% to piperacillin/ tazobactam (the combination of beta-lactam/beta-lactamase inhibitor).…”

Section: Discussionsupporting

confidence: 89%

“…This occurs largely because of the inappropriate use of antibiotics and free access to antibiotics in many countries. Thus, treating physicians must identify the presence of MDR organisms and their associated risk factors, like hospitalization, irrational use of antibiotics, chronic wounds and duration of diabetes, to improve outcomes, as stated by Data et al [29] and Anvarinejad et al (29,33). Most patients had suffered from diabetes for a long time, and their foot ulcers remained unhealed for long time, e.g.…”

Section: Proteus Mirabilis Positive By Pcr For Beta-lactamases Genesmentioning

confidence: 99%

Distribution of blaTEM, blaSHV, blaCTX-M, blaOXA, and blaDHA in Proteus mirabilis Isolated from Diabetic Foot Infections in Erbil, Iraq

Hamid

Taha

Abdulwahid

2020

Cell Mol Biol (Noisy-le-grand)

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Diabetic foot infection is considered to be one of the most important medical, economic, and social problems and a major cause of morbidity and mortality. Proteus mirabilis is a common etiologic agent of diabetic foot infections. This study aimed to determine the prevalence of beta-lactamase genes in P. mirabilis recovered from patients with diabetic foot wounds in Erbil, Iraq. Eighteen P. mirabilis isolated from 84 patients with diabetic foot ulcers were first phenotypically examined for the existence of extended-spectrum beta-lactamases by combined disc method and double-disc synergy method that all isolates showed positive results by both methods. The results were confirmed genetically by PCR to detect beta-lactamase-encoding genes (bla TEM , bla SHV , bla CTX-M , bla OXA , and bla DHA ). The results revealed that all isolates contained extended-spectrum beta-lactamase and that 80% of the P. mirabilis isolates contained bla DHA , 60% had bla TEM , 53.3% had bla OXA , and 26.7% had bla CTX-M , whereas no isolates harbored bla SHV . The coexistence of two or more beta-lactamase genes in one isolate was observed. The existence of four genes (bla TEM + bla CTX-M + bla OXA + bla DHA ) in the same isolate was documented in two isolates. In conclusion, this is the first study that reports a high prevalence of bla DHA and the coexistence of four resistance genes in the same organism in P. mirabilis isolated from diabetic foot patients in Iraq.

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“…Other variables included in the model are well-known risk factors for the adverse outcomes of antibiotic treatment: prior antibiotic treatment, nasogastric tube, and low albumin level are all risk factors for Clostridoides difficile infection [ 19 , 20 ]. Peripheral vascular disease, central venous catheter, indwelling urinary catheter, and prior antibiotic treatment are risk factors for multidrug-resistance infection [ 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting In-Hospital Antibiotic Use in the Medical Department: Derivation and Validation Study

Poran

Elbaz²,

Turjeman‬‏³

et al. 2022

Antibiotics

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Background: The rise of multi-drug-resistant pathogens and nosocomial infections among hospitalized patients is partially attributed to the increased use of antibiotic therapy. A prediction model for in-hospital antibiotic treatment could be valuable to target preventive strategies. Methods: This was a retrospective cohort study, including patients admitted in 2018 to medical departments and not treated with antibiotics during the first 48 h. Data available at hospital admission were used to develop a logistic model to predict the probability of antibiotic treatment during hospitalization. The performance of the model was evaluated in two independent validation cohorts. Results: In the derivation cohort, antibiotic treatment was initiated in 454 (8.1%) out of 5592 included patients. Male gender, lower functional capacity, prophylactic antibiotic treatment, medical history of atrial fibrillation, peripheral vascular disease, solid organ transplantation, chronic use of a central venous catheter, urinary catheter and nasogastric tube, albumin level, mental status and vital signs at presentation were identified as predictors for antibiotic use during hospitalization and were included in the prediction model. The area under the ROC curve (AUROC) was 0.72 (95% CI 0.70–0.75). In the highest probability group, the percentage of antibiotic treatment was 18.2% (238/1,307). In the validation cohorts, the AUROC was 0.73 (95% CI 0.68–0.77) and 0.75 (95% CI 0.72–0.78). In the highest probability group, the percentage of antibiotic treatment was 12.5% (66/526) and 20.7% (244/1179) of patients. Conclusions: Our prediction model performed well in the validation cohorts and was able to identify a subgroup of patients at high risk for antibiotic treatment.

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Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients

Cited by 18 publications

References 10 publications

Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate

Isolation and characterization of bacteria from diabetic foot ulcer: amputation, antibiotic resistance and mortality rate

Distribution of blaTEM, blaSHV, blaCTX-M, blaOXA, and blaDHA in Proteus mirabilis Isolated from Diabetic Foot Infections in Erbil, Iraq

Predicting In-Hospital Antibiotic Use in the Medical Department: Derivation and Validation Study

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