Pseudomonal Diabetic Foot Infections: Vive la Différence?

Uçkay, İlker; Lebowitz, Dan; Kressmann, Benjamin; Dach, Elodie von; Lipsky, Benjamin A.; Gariani, Karim

doi:10.1016/j.mayocpiqo.2022.04.005

Cited by 7 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to what many clinicians believe, the specific causative DFI pathogen is generally not a major determinant for the outcome of therapy [2][3][4][5][6][7][8], unless it is resistant to multiple antibiotic agents [4]. Indeed, in almost all published reports regarding DFIs, clinical or microbiological outcomes are no worse for patients infected with "difficult" pathogens such as methicillin-resistant Staphylococcus aureus [2], Pseudomonas aeruginosa [3,5], or obligately anaerobic bacteria than with other pathogens [6][7][8]. Even in randomized, controlled trials of treatment of DFI, the causative pathogen(s) is a negligible factor in treatment failure, compared to other parameters [9,10].…”

Section: Introductionmentioning

confidence: 82%

“…There are multiple reasons for the poor outcomes, including limb ischemia, inadequate pressure off-loading of the foot, and a lack of patient adherence to the prescribed treatment [1]. In contrast to what many clinicians believe, the specific causative DFI pathogen is generally not a major determinant for the outcome of therapy [2][3][4][5][6][7][8], unless it is resistant to multiple antibiotic agents [4]. Indeed, in almost all published reports regarding DFIs, clinical or microbiological outcomes are no worse for patients infected with "difficult" pathogens such as methicillin-resistant Staphylococcus aureus [2], Pseudomonas aeruginosa [3,5], or obligately anaerobic bacteria than with other pathogens [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Influence of Skin Commensals on the Therapeutic Outcomes of Surgically-Debrided Diabetic Foot Infections

Uçkay¹,

Lebowitz²,

Kressmann³

et al. 2022

Preprint

View full text Add to dashboard Cite

In diabetic foot infections (DFI), the clinically virulence of skin commensals are generally presumed to be of low virulence. In this single-center study, we divided the wound isolates into two groups: skin commensals (coagulase-negative staphylococci, micrococci, corynebacteria, cutibacteria); and, pyogenic pathogens, and followed the patients for ≥ 6 months. In 1,018 DFI episodes (392 [39%] with osteomyelitis), we identified skin commensals as the sole culture isolates (without accompanying pyogenic pathogens) in 54 cases (5%). After treatment (antibiotic therapy [median of 20 days], hyperbaric oxygen in 98 cases [10%]), 251 episodes (25%) were clinical failures. Group comparisons between those growing only skin commensals and controls found no difference in clinical failure (17% vs 24 %, p=0.23) or microbiological recurrence (11% vs 17 %, p=0.23). The skin commensals were mostly treated with non-beta-lactam oral antibiotics. In multivariate logistic regression analysis, isolation of only skin commensals was not associated with failure (odds ratio 0.4, 95% confidence interval 0.1-3.8). Clinicians might wish to consider these isolates as potential pathogens when selecting a targeted antibiotic regimen, which may equally base on oral non-beta-lactam antibiotic agents susceptible to the corresponding skin pathogens.

show abstract

Section: Introductionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

The Influence of Skin Commensals on the Therapeutic Outcomes of Surgically-Debrided Diabetic Foot Infections

Uçkay¹,

Lebowitz²,

Kressmann³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, P. aeruginosa has a remarkable ability to acquire antibiotic resistance against most of the commonly used antibiotics, making its eradication a difficult task[ 143 , 146 , 149 ]. P. aeruginosa can easily establish an infection on intact healthy skin[ 147 , 148 ] and even more so on already vulnerable tissues in immunocompromised patients such as in diabetic foot wounds[ 146 , 148 , 149 ]. The guidelines provided by the American Infectious Diseases Society for DFIs state that empiric therapy directed against P. aeruginosa is usually not recommended[ 147 , 149 ].…”

Section: The Most Prevalent Bacterial Dfismentioning

confidence: 99%

“…P. aeruginosa can easily establish an infection on intact healthy skin[ 147 , 148 ] and even more so on already vulnerable tissues in immunocompromised patients such as in diabetic foot wounds[ 146 , 148 , 149 ]. The guidelines provided by the American Infectious Diseases Society for DFIs state that empiric therapy directed against P. aeruginosa is usually not recommended[ 147 , 149 ]. However, once the infection is identified, it is recommended to perform antibiotic susceptibility tests of the bacterial isolates[ 151 - 153 ].…”

Section: The Most Prevalent Bacterial Dfismentioning

confidence: 99%

“…However, once the infection is identified, it is recommended to perform antibiotic susceptibility tests of the bacterial isolates[ 151 - 153 ]. There are several classes of antibiotics that are proposed as a monotherapy or as a combination therapy for eradication of P. aeruginosa in DFIs, including fluroquinolones, aminoglycosides, and colistin[ 83 , 84 , 143 , 147 , 151 , 152 ].…”

Section: The Most Prevalent Bacterial Dfismentioning

confidence: 99%

See 1 more Smart Citation

What’s old is new again: Insights into diabetic foot microbiome

Rajab¹,

Hegazy²

2023

World J Diabetes

View full text Add to dashboard Cite

Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians. The prevalence of diabetes in the global population continues to grow to alarming levels year after year, causing an increase in the incidence of diabetes complications and health care costs all over the world. One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients, which is considered a definitive factor in all cases. Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection, limb amputations, and life-threatening systemic infections. In this review, we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior. In addition, we shed light on the different treatment strategies that aim at eradicating the infection.

show abstract

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries

Abbas,

Gangji,

Uçkay

2024

Endocrino Diabet & Metabol

Self Cite

View full text Add to dashboard Cite

BackgroundDiabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI).MethodsWe evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource‐poor settings such as in Africa.ResultsThe management of DFI very often is adapted to the financial and practical realities of the resource‐poor regions. The application of the point‐of‐care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi‐quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs.ConclusionsIn the practical and resource‐saving management of DFI, the ‘therapeutic’ use of Gram stains is not common in resource‐rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.

show abstract

Pseudomonal Diabetic Foot Infections: Vive la Différence?

Cited by 7 publications

References 27 publications

The Influence of Skin Commensals on the Therapeutic Outcomes of Surgically-Debrided Diabetic Foot Infections

The Influence of Skin Commensals on the Therapeutic Outcomes of Surgically-Debrided Diabetic Foot Infections

What’s old is new again: Insights into diabetic foot microbiome

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries

Contact Info

Product

Resources

About