Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series

Aragón‐Sánchez, Javier; Lázaro‐Martínez, José Luis; Quintana-Marrero, Yurena; Hernández-Herrero, María J.; García-Morales, Esther; Cabrera-Galván, Juan J.; Montesinos, Juan Vicente Benéit

doi:10.1111/j.1464-5491.2009.02714.x

Cited by 46 publications

(35 citation statements)

References 18 publications

(35 reference statements)

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“…The overall proportion of patients in whom complete healing was obtained was 85%, with a mean healing time of 15 weeks, slightly shorter than the 26 weeks reported in the study by Kessler et al (21). Univariate analysis did not identify any parameter associated with the patient outcome, especially methicillin-resistant S. aureusrelated infections, which is consistent with a previous study from Aragón-Sánchez et al (22).…”

Section: Discussionsupporting

confidence: 81%

Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

et al. 2014

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OBJECTIVELittle is known about the optimal duration of antibiotic therapy for diabetic foot osteomyelitis (DFO). This study sought to compare the effectiveness of 6 versus 12 weeks of antibiotic therapy in patients with DFO treated nonsurgically (i.e., antibiotics alone). RESEARCH DESIGN AND METHODSThis was a prospective randomized trial comparing 6-versus 12-week duration of antibiotic treatment. Remission of osteomyelitis during the monitoring period was defined as complete and persistent (>4 weeks) healing of the wound (if present initially), absence of recurrent infection at the initial site or that of adjacent rays, and no need for surgical bone resection or amputation at the end of a follow-up period of at least 12 months after completion of antibiotic treatment. RESULTSForty patients followed at five French general hospitals were randomized be-

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Section: Discussionsupporting

confidence: 81%

Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

et al. 2014

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“…The prevalence of MRSA DFI among inpatients ranges from approximately 5% to 20%, with less clear trends than non-DFI SSTIs [5]. Interestingly, prior studies have not demonstrated worse outcomes among DFI patients with MRSA compared to other pathogens [9–12]. …”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Methicillin-Resistant Staphylococcus aureus Diabetic Foot Infections in a Large Academic Hospital: Implications for Antimicrobial Stewardship

et al. 2016

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IntroductionDiabetic foot infections (DFIs) are the leading cause of non-traumatic lower extremity amputations in the United States. Antimicrobials active against methicillin-resistant Staphylococcus aureus (MRSA) are recommended in patients with associated risk factors; however, limited data exist to support these recommendations. Due to the changing epidemiology of MRSA, and the consequences of unnecessary antibiotic therapy, guidance regarding the necessity of empirical MRSA coverage in DFIs is needed. We sought to 1) describe the prevalence of MRSA DFIs at our institution and compare to the proportion of patients who receive MRSA antibiotic coverage and 2) identify risk factors for MRSA DFI.MethodsThis was a retrospective cohort study of all adult, culture-positive DFI patients managed at University Hospital, San Antonio, TX between January 1, 2010 and September 1, 2014. Patient eligibility included a principal ICD-9-CM discharge diagnosis code for foot infection and a secondary diagnosis of diabetes. The primary outcome was MRSA identified in the wound culture. Independent variables assessed included patient demographics, comorbidities, prior hospitalization, DFI therapies, prior antibiotics, prior MRSA infection, and laboratory values. Multivariable logistic regression was used to identify risk factors for MRSA DFI.ResultsOverall, 318 patients met inclusion criteria. Patients were predominantly Hispanic (79%) and male (69%). Common comorbidities included hypertension (76%), dyslipidemia (52%), and obesity (49%). S. aureus was present in 46% of culture-positive DFIs (MRSA, 15%). A total of 273 patients (86%) received MRSA antibiotic coverage, resulting in 71% unnecessary use. Male gender (OR 3.09, 95% CI 1.37–7.99) and bone involvement (OR 1.93, 1.00–3.78) were found to be independent risk factors for MRSA DFI.ConclusionsAlthough MRSA was the causative pathogen in a small number of DFI, antibiotic coverage targeted against MRSA was unnecessarily high.

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“…It is commonly believed to be an important cause of poor outcome, increased duration of hospital stay, increased cost and increased mortality. [16][17][18][19] The second commonest bacteria isolated from the wounds was Mixed variety (16.98%) leading to amputation in 5 patients (55.56%). ESBL Kleb infected wounds also resulted in a very high incidence of amputation (80%).…”

Section: Discussionmentioning

confidence: 99%

A study on the relation of the severity of diabetic foot ulcers with the type of bacterial flora isolated from the wounds

Bikramjit

Gupta

2016

Int Surg J

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Background:The study is to determine the relation between severity of the diabetic foot ulcers and the organisms isolated from the wounds; its implications and prognosis with particular reference to the differences in the final outcome depending upon the type of organism infecting the wound. The study try to correlate the severity of the diabetic foot infection according to Meggit-Wagner classification, the incidence of amputation and the impact on the hospital stay with the difference of bacterial flora isolated from the wounds. This is an observational study done in 53 patients who were admitted in the surgical ward of a large private medical college in Jadavpur, India. It has been found from this study that the incidence and severity of diabetic foot ulcer is more in patients with some particular type of bacteria found in their wounds. A strong correlation is found in patients whose wounds were infected with some particular bacteria had resulted in more severe type of foot ulcers with higher incidence of amputation and concomitant longer hospital stay. Methods: An observational study was done in 53 patients who were admitted in the surgical ward of a teaching hospital in Kolkata, India. The youngest patient was aged 28 years and the oldest patient was 83 years of age. All of them presented with clinically infected foot ulcers. The patients were explained about the study methods in their own language and due consent was taken. A standardized proforma in English, Hindi and the vernacular languages was made for recording the necessary data. The standard X-ray plates were taken into consideration for determination of the involvement of underlying bones. The microbiological studies were done in all patients from the wound swabs of the foot ulcers. The outcome of the diabetic foot ulcer was assessed from the severity of the disease, the presence of the different bacterial flora in their wounds, the incidence of amputation and the duration of hospital stay. Results: The positive wound culture was found in 67.92 of patients, Methicillin resistant Staph. aureus (MRSA) was the commonest isolated organism (44.44%) followed by mixed bacterial flora (Staph. aureus, Streptococcus epidermidis, Peptococcus, and Bacteroides fragilis) in 16.98% of patients. ESBL Klebsiella was found in 13.89% of patients, Pseudomonas aeruginosa and Enterococcus feacalis were isolated in 8.33% of patients. 80% of ESBL infected wounds presented with Grade IV ulcers. The incidence of amputation was highest in patients whose wounds were colonized by MRSA and 60% of patients with ESBL Klebsiella infected wounds had hospital stay of more than three weeks. Conclusions: The study observed that the prognosis and outcome of a diabetic foot ulcer vary considerably with the specific type of bacteria colonizing the wound.

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Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series

Abstract: From our experience, where treatment is based on early and aggressive surgical treatment, MRSA bone infections are not associated with worse prognosis.

Cited by 46 publications

References 18 publications

Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study

Epidemiology of Methicillin-Resistant Staphylococcus aureus Diabetic Foot Infections in a Large Academic Hospital: Implications for Antimicrobial Stewardship

A study on the relation of the severity of diabetic foot ulcers with the type of bacterial flora isolated from the wounds

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