Are clindamycin and ciprofloxacin appropriate for the empirical treatment of diabetic foot infections?

Vries, Martin G. de; Ekkelenkamp, Miquel B.; Peters, Edgar J.G.

doi:10.1007/s10096-013-1977-7

Cited by 13 publications

(13 citation statements)

References 15 publications

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“…In contrast to the results of Gadepalli et al [ 11 ], Pseudomonas aeruginosa accounted for the highest percentage of the GNB, followed by Klebsiella and Escherichia coli . Further analysis showed that the most common GNB types among patients with chronic wounds were Pseudomonas aeruginosa , Klebsiella , and Proteus , which accounted for 16.6%, 13.3%, and 12.2%, respectively; these results were similar to the findings of de Vries et al [ 14 ]. The Enterobacteriaceae family showed the highest susceptibility to ertapenem and imipenem.…”

Section: Discussionsupporting

confidence: 88%

“…After antibiotic therapy, the positive rate of bacterial culture decreased significantly, and the proportion of GNB and fungi increased significantly. Studies have shown that GNB infections are positively correlated with amputation and negatively correlated with DFU healing [ 14 ], suggesting that GNB infections are a serious DFI warning. A study from Pakistan from 2013-2014 [ 15 ]showed that mixed infections accounted for the majority (56.9%), whereas the results of our study showed predominantly single-pathogen infections (56.8%).…”

Section: Discussionmentioning

confidence: 99%

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Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China

Pan

Leng

et al. 2018

Journal of Diabetes Research

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Objective To investigate the microbial distribution and drug susceptibility among diabetic foot ulcers (DFUs) with different Wagner grades and between acute and chronic DFUs. Methods. We enrolled 428 DFU patients who were hospitalized and treated in the Southwest Hospital. We collected deep ulcer secretion for microbial culture and drug susceptibility tests and analyzed the results. We reexamined 67 patients with poor anti-infection efficacy and analyzed microbial species. Results: The 354 positive samples included 201 cases (56.8%) of single-pathogen infections and 153 cases (43.2%) of multiple-pathogen infections before antibiotic therapy. A total of 555 strains were cultivated, including 205 (36.9%) strains of gram-positive organisms (GPOs), 283 (51.0%) gram-negative bacilli (GNB), and 67 (12.1%) fungal strains. In terms of distribution, patients with different Wagner grades had different bacterial composition ratios (P < 0.01). Patients with Wagner grades 3–5 mainly had GNB. The specimens from chronic ulcer wounds were primarily GNB (54.2%), whereas fungi accounted for 14.4% of the infections; the distribution was significantly different from that of acute ulcers (P < 0.01). The susceptibility tests showed that the Staphylococcus genus was more susceptible to vancomycin, linezolid, and tigecycline. Tobramycin was the most effective drug (97%) for the treatment of Escherichia coli, followed by ertapenem (96.4%), imipenem (93.5%), and cefotetan (90%). Most of the remaining GNB were susceptible to antibiotics such as carbapenems, aminoglycosides, fluoroquinolones, ceftazidime, cefepime, and piperacillin-tazobactam (>63.2%). After antibiotic therapy, the positive rate of microbial culture was 52.2%, and the proportion of GNB and fungi increased to 68.9% and 20%. Conclusion The distribution and types of bacteria in diabetic foot infection (DFI) patients varied with the different Wagner classification grades, courses of the ulcers, and antibiotic therapy. Multidrug resistance were increased, and the clinical treatment of DFIs should select the most suitable antibiotics based on the pathogen culture and drug susceptibility test results.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China

Pan

Leng

et al. 2018

Journal of Diabetes Research

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“…As per Canadian study conducted by Chow et al, showed clindamycin dominated other drugs such as cephalexin, cloxacillin, levofloxacin, and amoxicillin+clavulanate with the lowest CER in the treatment of DFT [12]. Radji et al conducted a study in Indonesia found that the most common infecting microorganisms on pus culture to be [13]. Commonly administered antibiotics were ceftriaxone 40.0%, ciprofloxacin 11.4%, and meropenem 8.6%.…”

Section: Discussionmentioning

confidence: 96%

Appropriate Empirical Management of Microbial Infections in a Tertiary Care Hospital: A Cost- Effectiveness Approach.

N¹,

Simon²,

Tomy³

et al. 2018

Asian J Pharm Clin Res

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Objective: Antibiotics are mostly prescribed empirically to decrease health-care costs. This has led to the misuse of antibiotics thereby making them inefficient in the treatment of infections. The aim of this study was to determine the appropriate, cost-effective drug for the empirical therapy in microbial infections.Methods: A prospective observational study was conducted for a period of 6 months. Cost-effectiveness ratio (CER) of these antibiotics prescribed was calculated to determine the cost-effective drugs for the common microorganisms and common infections.Results: In a population of 205 patients, 54.6% were treated based on antibiotic sensitivity pattern whereas 45.3% were treated empirically. In known microbial infections, the prevailing microorganism was extended-spectrum beta-lactamase (ESBL) producing Escherichia-coli (14.3%), Staphylococcus aureus (10.6%), Pseudomonas aeruginosa (9.8%), Klebsiella pneumonia (9.8%), and K. pneumoniae ESBL (6.81%). Based on the CER, the most cost-effective drugs for these organisms were found to be ciprofloxacin, clindamycin, ofloxacin, levofloxacin, and amikacin, respectively. In unknown microbial infection (empirical treatment), Diabetic Foot Infection (DFT) (25.8%), respiratory tract infection (RTI) (23.6%), and urinary tract infection (UTI) (16.1%) were the most common infections. The most cost-effective drugs for these infections were clindamycin, levofloxacin, and azithromycin, respectively. The predominant microorganism in DFT was found to be S. aureus (71%), in UTI was found to be E. coli ESBL (52%), and in RTI were found to be P. aeruginosa (42.4%) and K. pneumonia (32.3%). Conclusion:Appropriate empirical antibiotic treatment is associated with a lower medical cost and a better success rate in patients with microbial infections.

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“…16 It is possible that this fact is related to the wide range of factors that act synergistically together in establishment and proliferation of lesions of the diabetic foot. 5 Bacterial resistance was observed for several different drugs, but it was clindamycin, which is widely utilized in empirical regimes for treatment of the diabetic foot, to which bacteria were most often resistant (59%).…”

Section: 2814mentioning

confidence: 99%

“…Notwithstanding, it is evident that this drug should not be used in isolation, but in combination. De Vries et al 16 conducted a study to investigate utilization of clindamycin and the possibility of resistance, finding that empirical use of a combination of clindamycin with ciprofloxacin did not produce the desired results, with resistance of 15 to 22%. The same author also warns of resistance to ciprofloxacin, which also had a high rate of resistant bacteria in our study (28.7%).…”

Section: 2814mentioning

confidence: 99%

Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections

Oliveira

Filho²

2014

J. vasc. bras.

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Introduction: Diabetic foot infections are a difficult problem to solve, often requiring hospitalization and exposing patients to the risk of amputations. Identification of the most prevalent pathogens is useful for administration of antibiotic therapy, and can reduce mutilations. Objective: To identify the microbiological profile and resistance to antimicrobial drugs in a series of patients with infected diabetic feet. Material and methods: an epidemiological, retrospective and descriptive study based on analysis of medical records from diabetic patients with plantar lesions who underwent surgical treatment over a 24-month period at a public hospital. Data were collected on age, sex, length of hospital stay, cultures from lesions, antibiotic therapy administered, bacterial resistance and surgeries conducted, with statistical analysis of means and standard deviations. Results: There were 66 admissions of diabetic patients, the majority elderly people (77%). Hospital stays ranged from 2 to 29 days, with a mean of 12.42. There were 91 surgical procedures, resulting in some kind of amputation in 65% of cases. The most common bacterial group was enterobacteria (47%), followed by staphylococci (27%). Three patients (4.5%) had multi-resistant organisms. Resistance to clindamycin was the most common at 39 admissions (59%), followed by resistance to cephalexin, seen in 24 admissions (36%). Conclusions: Diabetic foot infections were most often caused by germs found in the community, in particular the enterococci. Bacterial resistance was very widespread and was most commonly associated with drugs for oral administration, in particular clindamycin and cephalexin.

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Are clindamycin and ciprofloxacin appropriate for the empirical treatment of diabetic foot infections?

Cited by 13 publications

References 15 publications

Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China

Distribution of Microbes and Drug Susceptibility in Patients with Diabetic Foot Infections in Southwest China

Appropriate Empirical Management of Microbial Infections in a Tertiary Care Hospital: A Cost- Effectiveness Approach.

Microbiological species and antimicrobial resistance profile in patients with diabetic foot infections

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