Diabetic foot infections: effective microorganisms and factors affecting the frequency of osteomyelitis and amputation

Abstract

Diabetic foot infection is one of the complications of diabetes; it has high mortality and morbidity and is also one of the most common causes of hospitalization in diabetes [1,2]. Diabetic foot infections generally start as a soft tissue infection secondary to a minor trauma, may advance to osteomyelitis, and eventually become a risk factor for amputation [3,4]. Approximately one-fourth of ABSTRACT 119Objectives. Diabetic foot infections are common reason for hospitalization and are associated with high morbidity and mortality. We aimed to evaluate the clinic features and predisposed causes of osteomyelitis and amputation of patients with diabetic foot infections. Methods. Patients with diabetic foot infections who admitted and hospitalized at Infection Diseases and Clinical Microbiology department between January 2012 and July 2014 were included. Osteomyelitis was evaluated using magnetic resonance imaging (MRI) or bone scintigraphy. Microbiological examinations (Gram staining and culture) of the debridement materials and pus aspiration materials of the lesions were performed. Results. Of the seventy-three diabetic foot infected patients, 37 (50.7%) were female, and 36 (49.3%) were male. The mean age of patients was 57±9.8 years. The mean duration of diabetes and HbA1c level were 13.3±5.3 years and 8.17±1.83%; respectively. Soft tissue infection without osteomyelitis was present in only 34 out of 73 (46.5%) patients. A total of 89 pathogens were identified in 52 patients whereas any microorganism was not identified in 28.7%. Polymicrobial infections were detected in 30 (41%) patients. The most common isolated microorganism was Pseudomonas aeruginosa (36.9%), followed by Staphylococcus aureus (31.5%) and Enterococcus spp. (13.6%). Of the 37 (50.7%) patients had a history of diabetic foot infection previously, osteomyelitis progression was higher (89.2%) and statistically significant in these patients. Twelve (16.4%) patients underwent amputation. Conclusions. Advanced age and presence of osteomyelitis were found as risk factors for amputation. In the presence of osteomyelitis, treatment of diabetic foot infections is difficult and amputation rate is higher. For this reason, diabetic foot infections should be promptly treated before the development of osteomyelitis, and multidisciplinary approach is needed.

Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections

“…Routine culture and antibiogram exams in a certain hospital allows knowledge of the microbiota of that population, subsidizing the development of local guidelines for initial empirical antibiotic therapy, promoting direct impact on treatment success, and even reducing costs, with a stepwise and more logical use of antimicrobials 7,8 . The inappropriate use of antimicrobials during the treatment of diabetic foot infections can aggravate the infection and even lead to the development of bacterial resistance 9 .…”

Características bacteriológicas das úlceras neuropáticas do pé em diferentes estádios da Diabetes Mellitus

“…Outros gram-positivos de grande importância encontrados com relevância e destacados em múltiplos estudos são Streptococcus agalactiae e Enterococcus faecalis. Entre as bactérias gram-negativas mais frequentes estão as Enterobacteriaceae como Proteus mirabilis, Klebisiella pneumonae, Escherichia coli e Pseudomonas aeruginosas, sendo encontradas especialmente em locais de climas quentes, como nas regiões tropicais (Uçkay et al, 2014) A realização de exames de cultura e antibiograma de forma rotineira nos serviços hospitalares permite o conhecimento da microbiota de uma determinada população, ajudando de forma decisiva na elaboração de diretrizes locais de antibioterapia empírica inicial, e desta forma, promovem um impacto direto no sucesso do tratamento e até mesmo na redução de custos com o uso escalonado e mais racional dos antimicrobianos (Sonmezer et al, 2015) (Hatipoglu et al, 2014).…”