Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers

Richard, Jean-Louis; Sotto, Albert; Jourdan, Nathalie; Combescure, Christophe; Vannereau, D.; Rodier, M.; Lavigne, Jean‐Philippe

doi:10.1016/j.diabet.2008.02.005

Cited by 101 publications

(117 citation statements)

References 21 publications

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“…Hartemann-Heurtier et al, 8 Richard et al 11 and ElMakki Ahmed et al 12 administered similar antibiotic therapies. All of them started their patients on broad-spectrum treatment for infections, and the antibiotic therapy was adapted based on the results from microbiological studies, so that it would cover the most likely pathogenic organisms.…”

Section: Resultsmentioning

confidence: 99%

“…HartemannHeurtier et al 10,11 and the last and most recent two appeared in 2010. 12,13 This small number of studies may be due to difficulty in monitoring diabetic patients from the onset of the infection until wound healing, thus making it complex to obtain a homogeneous sample.…”

Section: Resultsmentioning

confidence: 99%

“…The healing times observed by the first authors were 17.8 weeks (MSSA) and 35.4 weeks (MRSA), while the second authors reported a healing time of 12 weeks, regardless of the infecting pathogen. Hartemann-Heurtier et al 8 and Richard et al 11 ranked MRSA among MDRO. Hartemann-Heurtier et al 8 found healing times of 4.6 ± 8.4 months (MDRO+) and 6.7 ± 13 months (MDRO-), and Richard et al…”

Section: Resultsmentioning

confidence: 99%

“…Hartemann-Heurtier et al 8 agreed that indiscriminate use of broad-spectrum antibiotics promoted the emergence of resistance, but they argued that MRSA was acquired more often from cross-transmission than from antibiotic overuse. According to Richard et al, 11 isolation of multidrug resistant microorganisms (MDRO) seemed to have no significant impact on healing time when early aggressive treatment of wound infection, including immediate broad-spectrum antibiotics (active against MRSA) were administered, followed by adjustment according to culture results.…”

Section: Resultsmentioning

confidence: 99%

“…Kim et al 10 used modified resection arthroplasty to completely remove the infected phalangeal bone and to suture the dorsal wound and extensor tendon of 52 diabetic patients: 23 of these were infected by S. aureus, including seven cases of MRSA. Richard et al 11 followed up 188 diabetic patients, among whom 62 had wounds infected with MSSA and 37 with MRSA. In a prospective cohort study, ElMakki Ahmed et al 12 assessed the risk factors associated with hallux ulceration and the incidence of healing or amputation in 122 diabetic patients, of whom 56 were infected by S. aureus.…”

Section: Resultsmentioning

confidence: 99%

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Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

et al. 2011

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CONTEXT AND OBJECTIVE: Staphylococcus aureus is the most frequent agent isolated in diabetic foot infections and may be associated with changes to wound healing times. The aim of this study was to perform a systematic review of the literature, including studies that assessed the efficacy of any clinical or surgical intervention, as well as oral or topical therapy for diabetic ulcers infected with S. aureus. DESIGN AND SETTING:Systematic review with a search conducted in databases. METHODS:We conducted a systematic review with a comprehensive search in the Lilacs, SciELO, PubMed/Medline, Old Medline, Embase and Cochrane Library databases, for articles published from 1966 to 2010. The articles selected were limited to studies on diabetic patients with wounds infected with S. aureus for whom their healing was followed up, with the use of either antibiotics or experimental treatments. Animal studies and those that did not report the wound healing, as well as review articles, were excluded. RESULTS:Five studies that met the inclusion and exclusion criteria were analyzed. CONCLUSIONS:There are few studies reporting the healing of wounds infected with S. aureus in diabetic patients, although this is the most commonly found pathogen in this type of wound and it frequently consists of methicillin-resistant S. aureus (MRSA). There is insufficient evidence to support early use of broad-spectrum antibiotics against MRSA to promote healing of diabetic ulcers, since antibiotic resistance may develop from such treatment.This highlights the need for further studies on the subject. RESUMOCONTEXTO: Staphylococcus aureus é o agente mais frequentemente isolado nas infecções de pé em pacientes diabéticos e pode estar associado a mudança no tempo de cicatrização de feridas. O objetivo deste estudo foi realizar uma revisão sistemática da literatura, incluindo estudos que avaliaram a eficácia de qualquer intervenção clínica, cirúrgica, bem como terapia oral ou tópica para o tratamento de úlceras diabéticas infectadas com o S. aureus. TIPO DE ESTUDO E LOCAL:Revisão sistemática com busca realizada em bancos de dados. MÉTODOS:Realizamos uma revisão sistemática com uma busca abrangente nos bancos de dados Lilacs, SciELO, PubMed/Medline, Old Medline, Embase e no banco de dados da biblioteca Cochrane, publicados entre 1966 e 2010. Os artigos selecionados foram limitados aos estudos com feridas infectadas por S. aureus de pacientes diabéticos, que tiveram cicatrização relatada, quer pela utilização de antibióticos ou por substâncias experimentais. Foram excluídos os estudos com animais e os que não relataram a cicatrização das feridas, bem como artigos de revisão. RESULTADOS:Foram analisados cinco estudos que obedeceram aos critérios de inclusão e exclusão.CONCLUSÕES: Raros estudos relataram cicatrização de feridas infectadas com S. aureus em pacientes diabéticos, embora este seja o patógeno mais comumente encontrado neste tipo de ferida, sendo frequentemente resistente à meticilina MRSA (methicillin-resistant S. aureus). Não há evidê...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

et al. 2011

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From the Cradle to the Grave of an Infection: Host‐Pathogen Interaction Visualized by Intravital Microscopy

2019

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During infections, interactions between host immune cells and the pathogen occur in distinct anatomical locations and along defined time scales. This can best be assessed in the physiological context of an infection in the living tissue. Consequently, intravital imaging has enabled us to dissect the critical phases and events throughout an infection in real time in living tissues. Specifically, advances in visualizing specific cell types and individual pathogens permitted tracking the early events of tissue invasion of the pathogen, cellular interactions involved in the induction of the immune response as well the events implicated in clearance of the infection. In this respect, two vantage points have evolved since the initial employment of this technique in the field of infection biology. On the one hand, strategies acquired by the pathogen to establish within the host and circumvent or evade the immune defenses have been elucidated. On the other hand, analyzing infections from the immune system's perspective has led to insights into the dynamic cellular interactions that are involved in the initial recognition of the pathogen, immune induction as well as effector function delivery and immunopathology. Furthermore, an increasing interest in probing functional parameters in vivo has emerged, such as the analysis of pathogen reactivity to stress conditions imposed by the host organism in order to mediate clearance upon pathogen encounter. Here, we give an overview on recent intravital microscopy findings of hostpathogen interactions along the course of an infection, from both the immune system's and pathogen's perspectives. We also discuss recent developments and future perspectives in extracting intravital information beyond the localization of pathogens and their interaction with immune cells. Such reporter systems on the pathogen's physiological state and immune cell functions may prove useful in dissecting the functional dynamics of hostpathogen interactions.

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Classification of foot ulcers in people with diabetes: A systematic review

Monteiro‐Soares

Hamilton

Russell

et al. 2023

Diabetes Metabolism Res

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BackgroundClassification and scoring systems can help both clinical management and audit the outcomes of routine care.AimThis study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.MethodsWe searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.ResultsWe found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt‐Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.ConclusionDespite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.

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Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers

Cited by 101 publications

References 21 publications

Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

Interventions for wound healing among diabetic patients infected with Staphylococcus aureus: a systematic review

From the Cradle to the Grave of an Infection: Host‐Pathogen Interaction Visualized by Intravital Microscopy

Classification of foot ulcers in people with diabetes: A systematic review

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