Clinical and bacteriological survey of diabetic foot infections in Lisbon

Abstract

Infection Microbiology Portugal a b s t r a c tAims: An epidemiological survey of diabetic foot infections (DFIs) in Lisbon, stratifying the bacterial profile based on patient demographical data, diabetic foot characteristics (PEDIS classification), ulcer duration and antibiotic therapy.Methods: A transversal observational multicenter study, with clinical data collection using a structured questionnaire and microbiological products (aspirates, biopsies or swabs collected using the Levine method) of clinically infected foot ulcers of patients with diabetes mellitus (DM).Results: Forty-nine hospitalized and ambulatory patients were enrolled in this study, and 147 microbial isolates were cultured. Staphylococcus was the main genus identified, and methicillin-resistant Staphylococcus aureus (MRSA) was present in 24.5% of total cases. In the clinical samples collected from patients undergoing antibiotic therapy, 93% of the antibiotic regimens were considered inadequate based on the antibiotic susceptibility test results. The average duration of an ulcer with any isolated multi-drug resistant (MDR) organism was 29 days, and previous treatment with fluoroquinolones was statistically associated with multidrug resistance.Conclusions: Staphylococcus aureus was the most common cause of DFIs in our area. Prevalence and precocity of MDR organisms, namely MRSA, were high and were probably related to previous indiscriminate antibiotic use. Clinicians should avoid fluoroquinolones and more frequently consider the use of empirical anti-MRSA therapy.

In vitro design of a novel lytic bacteriophage cocktail with therapeutic potential against organisms causing diabetic foot infections

“…Of these isolates, 44 were from DFIs. The epidemiology, clinical details and specific microbiology of our collection of DFI isolates have been described previously (Mendes et al, 2012). All isolates were stored in tryptone soy broth (TSB; Biokar Diagnostics) with 15 % glycerol (w/v) at 270 uC until needed.…”

“…In current clinical practice, DFI treatment includes debridement and systemic antibiotics (Lipsky et al, 2004). The increased incidence of antibioticresistant bacterial strains, such as meticillin-resistant Staphylococcus aureus and pan-drug-resistant, non-fermenting, Gram-negative bacilli, threatens the efficacy of antimicrobial therapy (Mendes et al, 2012). Thus, it is necessary to identify new therapeutic strategies for DFIs.…”

“…ml 21 inoculum used in previous time-kill studies testing antibiotics (NCCLS, 1999) because we wanted to mimic a worst-case scenario, similar to that found in wounds (Loc-Carrillo et al, 2012). In a previous epidemiological study (Mendes et al, 2012), microbiological products (aspirates, biopsies and swabs collected using the Levine method) of clinically infected foot ulcers in patients with diabetes were found to have a maximum bioburden of 10 7 c.f.u. (g tissue) 21 (or cm 22 of ulcer area).…”

Correlation of CRP level with glycemic control in diabetic foot patients and its sequelae

“…15 One of the common complications of long term diabetes is diabetic foot and bacterial infections are the commonest foot infections of patients with diabetes in clinical practice. 16 These infections and their squeal cause considerable disability and often the reason for lowerlimb amputation. 17 Even with appropriate treatment, some patients must undergo major amputation or a limb salvage operation.…”

Development of Herbal-Silver Nano Composite (HSNC): Antibacterial Evaluation and Investigation of fnb A and fnb B Genes Coding Fibronectin-binding Proteins in Staphylococcus aureus

“…The lifetime risk of developing foot ulcer in diabetic patients is about 25%. The high rate of infection in such ulcers is considered as an important cause of amputation in 25-50% of diabetics and therefore is associated with morbidity and mortality in a large number of individuals (Mendes et al, 2012). Diabetic foot infections (DFI) are often polymicrobial and can be caused by several pathogens, A novel composite synthesized using silver nanoparticles with Terminalia chebula extracts was selected as the primary objective of this present research.…”