Microbial ecology of interdigital infections of toe web spaces

Kates, S.G.; Nordström, Katrina; McGinley, Kenneth J.; Leyden, James J.

doi:10.1016/0190-9622(90)70075-s

Cited by 52 publications

(52 citation statements)

References 17 publications

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“…Exacerbation of a mild dermatophyte infection (dermatophytosis simplex) can arise in the occlusive environment of the toe web space. Fungal infection induces damage to the stratum corneum, which allows overgrowth of resident bacteria and maceration, itching, and often malodor at the site (15,20).…”

Section: Discussionmentioning

confidence: 99%

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

et al. 2010

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The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5-؋ 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.Diabetes is now a worldwide epidemic. Among the 191 WHO member states, India has the highest number of people with diabetes (37). Fifteen percent of patients with diabetes develop lower-extremity ulcers during their lifetimes. Diabetes is the most common cause for nontraumatic amputation of lower extremities (1, 39). Eighty-five percent of these lowerlimb amputations are preceded by polymicrobial infections of the wound (23,26,36). Despite proper surgical and antibacterial therapy for infected diabetic lower-limb wounds (DLWs), the global long-term outcome of patients was found to be poor; only Ͻ50% of these patients had global therapeutic success (16,22).Fungal infections among immunocompromised patients are one of the major health concerns worldwide (5, 13, 19), but the spectrum of fungi infecting DLWs and their pathogenicity have not yet been studied thoroughly. Therefore, clinicians and surgeons treating diabetic foot wounds suspect only bacterial infections and treat them with antibacterial agents. They do not routinely send deep tissue from the wound bed for fungal culture and sensitivity, either due to lack of literature support or due to the assumption that there would not be any fungal infections in the DLWs. Surprisingly, our retrospective pilot study showed 27.9% positive fungal cultures in 3...

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Section: Discussionmentioning

confidence: 99%

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

et al. 2010

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“…Previous studies have described the dynamics of toe web infections, where fungal infections induce damage to the stratum corneum, which is followed by a bacterial superinfection. This might also be the case for S. lugdunensis toe infections (15,21).…”

Section: Topley and Wilson's Microbiology And Microbial Infectionsmentioning

confidence: 99%

Staphylococcus lugdunensis , a Common Cause of Skin and Soft Tissue Infections in the Community

et al. 2009

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Staphylococcus lugdunensis, a rare cause of severe infections such as native valve endocarditis, often causes superficial skin infections similar to Staphylococcus aureus infections. We initiated a study to optimize the identification methods in the routine laboratory, followed by a population-based epidemiologic analysis of patients infected with S. lugdunensis in Viborg County, Denmark. Recognition of a characteristic Eikenella corrodens-like odor on Columbia sheep blood agar combined with colony pleomorphism and prominent ␤-hemolysis after 2 days of incubation, confirmed by API-ID-32 Staph, led to an 11-fold increase in the detection of S. lugdunensis. By these methods we found 491 S. lugdunensis infections in 4 years, corresponding to an incidence of 53 per 100,000 per year, an increase from 5 infections per 100,000 inhabitants in the preceding years. Seventy-five percent of the cases were found in general practice; these were dominated by skin abscesses (36%), wound infections (25%), and paronychias (13%). Fifty-six percent of the infections occurred below the waist, and toes were the most frequently infected site (21%). Only 3% of the patients suffered from severe invasive infections. The median age was 52 years, and the male/female ratio was 0.69. Our study shows that S. lugdunensis is a common cause of skin and soft-tissue infections (SSTI) and is probably underrated by many laboratories. S. lugdunensis should be accepted as a significant pathogen in SSTI and should be looked for in all routine bacteriological examinations, and clinicians should be acquainted with the name and the pathology of the bacterium.Staphylococcus lugdunensis, one of the coagulase-negative staphylococci (CoNS), was first described by Freney et al. 20 years ago (8). It causes severe infections similar to Staphylococcus aureus infections, especially acute endocarditis in prosthetic and native valves (14,24,29,30,36). Other infections such as osteomyelitis (17, 23), peritonitis (28), intravascular catheter infections (5, 32), prosthetic joint infections (26), and urinary tract infections have also been reported (10). S. lugdunensis has been reported as an important cause also of skin and soft tissue infections (SSTI), primarily in the groin (1, 39) and mammae (13,22,25,37,41).S. lugdunensis is part of the normal human skin flora and commonly colonizes the perineal region (1, 37, 39); however, carriage rates of different CoNS are not comprehensively accounted for, and only a few have looked for S. lugdunensis carriage (13, 16, 39).Our study was undertaken after two serious cases of S. lugdunensis infection, a fatal case of endocarditis with protracted bacterial identification but correct antibiotic treatment and a case of late-diagnosed osteomyelitis, which prompted an optimization of our routine microbiological methods for identification of S. lugdunensis. This subsequently increased the number of S. lugdunensis isolates significantly, especially in samples from patients in general practice, and encouraged us to conduct a prospectiv...

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“…In the axilla, the resident flora consists of 106 organisms comprised of aerobic cocci, aerobic diphtheroids of varying species and gram-negative bacteria [7], Likewise, the mi croflora of the interdigital toe web space and perineum consists of millions of organisms comprising a wide variety of gram-positive and gram-negative species including Proteus spp.. Pseudomonas spp., Escherichia coli and Klebsiella spp. [8], Results obtained from the in vivo testing of an antimicrobial agent on a high-density flora of simple composition are not necessarily reflective of what might oc cur in in vivo situations in which there is dense but complex composition of bacterial flora.…”

Section: Introductionmentioning

confidence: 99%

A New Method for in vivo Evaluation of Antimicrobial Agents by Translocation of Complex Dense Populations of Cutaneous Bacteria

Leyden

McGinley

Foglia

et al. 1996

Skin Pharmacol Physiol

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Previously, we described methods for measuring in vivo antimicrobial activity in which the resident bacterial flora of the forearm is expanded by occlusion with an impermeable plastic film, test agents are applied and quantitative cultures are obtained at varying time points. This methodology allows for an in vivo quantitative assessment of antimicrobial effects directed against a dense flora comprised primarily of staphylococci. This method may not be applicable to situations in which there is a high density of multiple species of bacteria. We describe herein new methods which permit in vivo determination of antimicrobial activity against a dense, mixed flora. Swabs moistened with a dilute nonionic detergent are used to remove bacteria from the subject’s axilla or groin which are then translocated to the subject’s forearm. Occlusion of the forearm with a large, sterile plastic chamber provides the necessary humid environment to yield a dense flora (10⁵–10⁶ CFU) consisting of gram-positive cocci, gram-positive coryneforms and gram-negative rods. In this manner, multiple test sites are created on each forearm allowing for the simultaneous evaluation of multiple antimicrobial agents in a single subject. This method allows for the evaluation of the immediate, as well as sustained, in vivo bactericidal effect of an antimicrobial agent against a dense mixed flora with quantitative cultures obtained at varying time points after application of the test agent. Furthermore, ecological pressures which select for resistant organisms or allow for an overgrowth of nonsensitive bacteria can be evaluated by determining the composition of the flora after single or repeated applications of a test agent. The testing methodologies described herein can provide relevant information regarding the antimicrobial effectiveness of an agent in a variety of situations such as use against the axillary flora (including its utility as a deodorant), use as a perineal cleanser for critically ill, hospitalized patients and use in situations where a dense mixed flora exists, e.g. stasis ulcers and infected intertriginous dermatoses.

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Microbial ecology of interdigital infections of toe web spaces

Cited by 52 publications

References 17 publications

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes

Staphylococcus lugdunensis , a Common Cause of Skin and Soft Tissue Infections in the Community

A New Method for in vivo Evaluation of Antimicrobial Agents by Translocation of Complex Dense Populations of Cutaneous Bacteria

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