First report of the predominance of clonal complex 398 Staphylococcus aureus strains in osteomyelitis complicating diabetic foot ulcers: a national French study

Senneville, Éric; Brière, M.; Neut, Christel; Messad, N.; Lina, Gérard; Richard, Jean-Louis; Sotto, Albert; Lavigne, Jean‐Philippe

doi:10.1111/1469-0691.12375

Cited by 29 publications

(41 citation statements)

References 23 publications

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“…Administer parenteral therapy initially for most severe infections and some moderate infections, with a switch to oral therapy when the infection is responding (strong; low). 23. Do not select a specific type of dressing for a diabetic foot infection with the aim of preventing an infection or improving its outcome (strong; high).…”

Section: Antimicrobial Therapymentioning

confidence: 99%

“…Strains of Staphylococcus aureus isolated from clinically non-infected ulcers have been shown to have a lower virulence potential than from ulcers that are infected [22]. Similarly, a clonal complex 398 methicillinsusceptible S. aureus with a tropism for bone has emerged as the main staphylococcal pathogen in one outbreak of diabetic foot osteomyelitis (DFO) [23].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Wound care 23. Do not select a specific type of dressing for a DFI with the aim of preventing an infection, or improving its outcome (strong; high).…”

Section: Duration Of Therapymentioning

confidence: 99%

“…Similarly, a clonal complex 398 methicillin‐susceptible S . aureus with a tropism for bone has emerged as the main staphylococcal pathogen in one outbreak of diabetic foot osteomyelitis (DFO) .…”

Section: Introductionmentioning

confidence: 99%

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IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

471

561

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Recommendations Classification/diagnosis Diabetic foot infection must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong; low). Assess the severity of any diabetic foot infection using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme (strong; moderate). Osteomyelitis For an infected open wound, perform a probe‐to‐bone test; in a patient at low risk for osteomyelitis, a negative test largely rules out the diagnosis, while in a high‐risk patient, a positive test is largely diagnostic (strong; high). Markedly elevated serum inflammatory markers, especially erythrocyte sedimentation rate, are suggestive of osteomyelitis in suspected cases (weak; moderate). A definite diagnosis of bone infection usually requires positive results on microbiological (and, optimally, histological) examinations of an aseptically obtained bone sample, but this is usually required only when the diagnosis is in doubt or determining the causative pathogen's antibiotic susceptibility is crucial (strong; moderate). A probable diagnosis of bone infection is reasonable if there are positive results on a combination of diagnostic tests, such as probe‐to‐bone, serum inflammatory markers, plain X‐ray, magnetic resonance imaging (MRI) or radionuclide scanning (strong; weak). Avoid using results of soft tissue or sinus tract specimens for selecting antibiotic therapy for osteomyelitis as they do not accurately reflect bone culture results (strong; moderate). Obtain plain X‐rays of the foot in all cases of non‐superficial diabetic foot infection (strong; low). Use MRI when an advanced imaging test is needed for diagnosing diabetic foot osteomyelitis (strong; moderate). When MRI is not available or contraindicated, consider a white blood cell‐labelled radionuclide scan, or possibly single‐photon emission computed tomography (CT) and CT (SPECT/CT) or fluorine‐18‐fluorodeoxyglucose positron emission tomography/CT scans (weak; moderate). Assessing severity At initial evaluation of any infected foot, obtain vital signs and appropriate blood tests, debride the wound and probe and assess the depth and extent of the infection to establish its severity (strong; moderate). At initial evaluation, assess arterial perfusion and decide whether and when further vascular assessment or revascularization is needed (strong; low). Microbiological considerations Obtain cultures, preferably of a tissue specimen rather than a swab, of infected wounds to determine the causative microorganisms and their antibiotic sensitivity (strong; high). Do not obtain repeat cultures unless the patient is not clinically responding to treatment, or occasionally for infection control surveillance of resistant pathogens (strong; low). Send collected specimens to the microbiology laboratory promptly, in sterile transport containers, accompanied by clinical information on the type of specimen and location of the wound (strong; low). Surgical treatment Consult...

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Section: Antimicrobial Therapymentioning

confidence: 99%

Section: Pathophysiologymentioning

confidence: 99%

“…Wound care 23. Do not select a specific type of dressing for a DFI with the aim of preventing an infection, or improving its outcome (strong; high).…”

Section: Duration Of Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

471

561

View full text Add to dashboard Cite

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“…This is related to multiple factors, including the increasing frequency of diabetesrelated foot problems, the growing rate of infections (especially community-acquired soft tissue infections) caused by MRSA, 25,[27][28][29][30][31][32][33] the concern about vancomycinresistant MRSA strains infecting diabetic patients, 34,35 rising vancomycin MIC levels for MRSA strains, 23,27 and recognition of tropisms of different staphylococcal species for bone. 36 Thus, we thought it would be important for clinicians to know if the presence of MRSA in DFI might negatively affect outcomes. If so, this might lead to efforts to find better treatment regimens for these infections.…”

mentioning

confidence: 99%

Do Diabetic Foot Infections With Methicillin-ResistantStaphylococcus aureusDiffer From Those With Other Pathogens?

Zenelaj

Bouvet

Lipsky

et al. 2014

The International Journal of Lower Extremity Wounds

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There is controversy as to whether or not diabetic foot infections (DFIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with worse outcomes than DFIs caused by other pathogens. To address this issue we performed a nonsystematic literature search of published articles in English language journals seeking studies reporting on the outcomes of DFIs related to their microbiology. We retrieved 48 articles published from 1999 to 2013 that described a total of 7771 cases of DFI. The overall proportion of DFIs with an isolate of S aureus was about 30%; just over one third of these (11% of all cases) were MRSA strains. Among the DFI cases caused by MRSA 1543 were episodes of soft tissue infections and 113 of osteomyelitis, while non-MRSA organisms caused 5761 soft tissue infections and 354 cases of osteomyelitis. Only 5 of the included articles attempted a comparison between DFI caused by MRSA and those caused by other pathogens, with no clear differences noted. The median total duration of antibiotic therapy for DFI caused by MRSA was 26 days, of which a median of 10 days was given intravenously. Only a few articles reported the proportion of patients with a recurrence, but they often did not differentiate between MRSA and non-MRSA cases. Four publications reported a worse functional or microbiological outcome in MRSA, compared to non-MRSA, cases, but the findings were variable and differences did not seem to be significant. Many trials failed to adjust for case-mix or to definitively demonstrate a relationship between microbiology and outcomes. Few of the articles specifically commented on whether the MRSA isolates were health care- or community-acquired strains. Notwithstanding the substantial limitations of the available literature, there does not appear to be a need for any special treatment for DFI caused by MRSA. The current guidelines for treating according to established international recommendations seem appropriate.

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Virulence factors and clonal diversity of Staphylococcus aureus in colonization and wound infection with emphasis on diabetic foot infection

Shettigar

Murali

2020

Eur J Clin Microbiol Infect Dis

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Foot ulcer is a common complication in diabetic subjects and infection of these wounds contributes to increased rates of morbidity and mortality. Diabetic foot infections are caused by a multitude of microbes and Staphylococcus aureus, a major nosocomial and community-associated pathogen, significantly contributes to wound infections as well. Staphylococcus aureus is also the primary pathogen commonly associated with diabetic foot osteomyelitis and can cause chronic and recurrent bone infections. The virulence capability of the pathogen and host immune factors can determine the occurrence and progression of S. aureus infection. Pathogen-related factors include complexity of bacterial structure and functional characteristics that provide metabolic and adhesive properties to overcome host immune response. Even though, virulence markers and toxins of S. aureus are broadly similar in different wound models, certain distinguishing features can be observed in diabetic foot infection. Specific clonal lineages and virulence factors such as TSST-1, leukocidins, enterotoxins, and exfoliatins play a significant role in determining wound outcomes. In this review, we describe the role of specific virulence determinants and clonal lineages of S. aureus that influence wound colonization and infection with special reference to diabetic foot infections.

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First report of the predominance of clonal complex 398 Staphylococcus aureus strains in osteomyelitis complicating diabetic foot ulcers: a national French study

Cited by 29 publications

References 23 publications

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Do Diabetic Foot Infections With Methicillin-ResistantStaphylococcus aureusDiffer From Those With Other Pathogens?

Virulence factors and clonal diversity of Staphylococcus aureus in colonization and wound infection with emphasis on diabetic foot infection

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