Risk Factors of Methicillin-Resistant Staphylococcus  Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

Lee, Jong Seok; Son, Seung Tae; Han, Seung Kyu

doi:10.22467/jwmr.2017.00164

Cited by 8 publications

(9 citation statements)

References 258 publications

(353 reference statements)

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“…Previous publications suggest numerous demographic and clinical patient characteristics – including male gender, smoking history, HbA1c level, diabetes, previous treatment history and amputation – that seem to be strong predictors of the presence of P. aeruginosa [ 6 , 7 ]. Patients that require amputations are often those with the most severe infections and long standing, deep foot ulcers, characteristics of the wound previously linked to identification of P. aeruginosa [ 13 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…An increase in the occurrence of multi-drug-resistant organisms (MDRO), like MRSA and Pseudomonas aeruginosa , in this population has also been reported [3–7]. MRSA has been isolated from about 23–50% of foot ulcers [3, 6, 8, 9]. P. aeruginosa has been considered a common pathogen in foot infections, with prevalence of 4.5%–31% in patients with diabetic ulcers [3, 6, 8, 10].…”

Section: Introductionmentioning

confidence: 99%

“…MRSA has been isolated from about 23–50% of foot ulcers [3, 6, 8, 9]. P. aeruginosa has been considered a common pathogen in foot infections, with prevalence of 4.5%–31% in patients with diabetic ulcers [3, 6, 8, 10]. While P. aeruginosa is reported in many patients, it is often a nonpathogenic coloniser when isolated from wounds.…”

Section: Introductionmentioning

confidence: 99%

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Development of predictive nomograms for clinical use to quantify the risk of isolating resistance prone organisms in patients with infected foot ulcers

et al. 2019

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Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%). P. aeruginosa prevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds of P. aeruginosa isolation (C statistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (C statistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected with P. aeruginosa or MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of predictive nomograms for clinical use to quantify the risk of isolating resistance prone organisms in patients with infected foot ulcers

et al. 2019

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“…Methicillin-resistant S. aureus (MRSA) is more often isolated from patients who have recently received antibiotic therapy, have been previously hospitalized, have nasal carriage of MRSA or osteomyelitis, or have a long wound duration (≥4 weeks) [ 38 39 ]. The majority of studies in the 1990s and 2000s reported a 15-30% prevalence of MRSA among patients with DFIs [ 38 ].…”

Section: Microbiologymentioning

confidence: 99%

“…Multi-drug resistant (MDR) Gram-negative microorganisms, including extended-spectrum beta-lactamase (ESBL) or carbapenemase-producing Enterobacteriaceae and MDR non-fermenters, are becoming a serious concern in tertiary referral hospitals in developing countries [ 10 25 50 51 52 ]. A recent study of Korean patients with DFIs revealed that the risk factors for Pseudomonas infection included smoking history and previous antibiotic use [ 39 ]. Two studies conducted in Korea reported antimicrobial susceptibility rates to Gram-negatives for imipenem, cefoperazone, piperacillin/tazobactam, aminoglycosides (gentamicin or amikacin), cefepime, and ciprofloxacin of 85.3-100%, 97.1%, 80.5-94.1% and 75.6%-94.1%, 91.4%, and 63.4%, respectively [ 29 32 ].…”

Section: Microbiologymentioning

confidence: 99%

Microbiology and Antimicrobial Therapy for Diabetic Foot Infections

Kwon

Armstrong

2018

Infect Chemother

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In addition to being the prime factor associated with amputation, diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, and reduced quality of life. The choice of appropriate antibiotics is very important in order to reduce treatment failure, antimicrobial resistance, adverse events, and costs. We reviewed articles on microbiology and antimicrobial therapy and discuss antibiotic selection in Korean patients with DFIs. Similar to Western countries, Staphylococcus aureus is the most common pathogen, with Streptococcus, Enterococcus, Enterobacteriaceae and Pseudomonas also prevalent in Korea. It is recommended that antibiotics are not prescribed for clinically uninfected wounds and that empirical antibiotics be selected based on the clinical features, disease severity, and local antimicrobial resistance patterns. Narrow-spectrum oral antibiotics can be administered for mild infections and broad-spectrum parenteral antibiotics should be administered for some moderate and severe infections. In cases with risk factors for methicillin-resistant S. aureus or Pseudomonas, empirical antibiotics to cover each pathogen should be considered. The Health Insurance Review and Assessment Service standards should also be considered when choosing empirical antibiotics. In Korea, nationwide studies need to be conducted and DFI guidelines should be developed.

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