The role of anaerobes in diabetic foot infections

Charles, Patrick G P; Uçkay, İlker; Kressmann, Benjamin; Emonet, Stéphane; Lipsky, Benjamin A.

doi:10.1016/j.anaerobe.2015.03.009

Cited by 79 publications

(56 citation statements)

References 58 publications

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“…Likewise, no study has linked any particular organism to treatment failure, which is not surprising given the polymicrobial nature of most DFIs. For example, we and others have shown that infection with methicillin‐resistant S. aureus or obligate anaerobes has not been shown to be more deleterious than other pathogens. Additionally, wound cultures from our patients demonstrated 112 different microbiological constellations, making adequate retrospective analyses difficult.…”

Section: Discussionmentioning

confidence: 93%

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Gariani

Lebowitz

Dach

et al. 2018

Diabetes Obesity Metabolism

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Section: Discussionmentioning

confidence: 93%

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Gariani

Lebowitz

Dach

et al. 2018

Diabetes Obesity Metabolism

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“…Third, we decided against analyzing on specific antibiotic agents used or the role of specific pathogens. There is no evidence that any specific systemic antibiotic regimen is superior for DFI treatment, or for any specific pathogen [1,16,29,30]. Fourth, pressure offloading is crucial not only for the prevention, but also for treating DFI.…”

Section: Discussionmentioning

confidence: 99%

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Waibel¹,

Berli²,

Catanzaro³

et al. 2019

Preprint

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Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI.Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is "remission of infection" after a minimal follow-up of two months. The 1 st RCT allocates the amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The 2 nd RCT randomizes the conservative approach in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, internist and infectiology care.During the surgeries, we collect tissues for BioBanking and future laboratory studies.Discussion: Both parellel RCT will enable to prescribe less antibiotics for DFI; for a conservative therapy and after amputation. Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4 th September 2019. Protocol version : 2 (15 th July 2019) Study settingThe Balgrist University Hospital in Zurich is a tertiary referral center for DFI and amputations (emergency and elective consultations with a 24-hour service) and affiliated to the University of Zurich. Regarding DFIs, it resumes a multidisciplinary team composed of four diabetic foot surgeons, three internist physicians, a hospital pharmacist, five specialized wound nurses, musculoskeletal expert radiologists, a diabetes nurse, three nutritionists, a shoemaker, a prosthesis specialist, and up to four infectious diseases physicians who are specialized in orthopedic infections. Moreover, this team is supported by an in-house company for orthopedic footwear (Balgrist Tec) and individual adaptations of off-loading devices, a re-education unit, physical therapy, a research campus (Balgrist

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“…The metataxonomic analysis revealed 22 different genera of anaerobes in the diabetic ulcer specimens. A few groups have studied the anaerobic infection of diabetic ulcer, and anaerobes have been found to play a major role in delayed wound healing . Smith et al have studied the new and recurring types of ulcer, and anaerobes were detected in nearly 87% of the samples.…”

Section: Discussionmentioning

confidence: 99%

Metataxonomic approach to decipher the polymicrobial burden in diabetic foot ulcer and its biofilm mode of infection

Suryaletha

John

Radhakrishnan

et al. 2018

International Wound Journal

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Chronic diabetic foot is a global burden affecting millions of people, and the chronicity of an ulcer is directly linked to the diverse bacterial burden and its biofilm mode of infection. The bacterial diversity of 100 chronic diabetic ulcer samples was profiled via traditional culturing method as well as metagenomic approach by sequencing the 16S rRNA V3 hyper-variable region on Illumina Miseq Platform (Illumina, Inc., San Diego, CA). All the relevant clinical metadata, including duration of diabetes, grade of ulcer, presence of neuropathy, and glycaemic level, were noted and correlated with the microbiota. The occurrence and establishment of bacterial biofilm over chronic wound tissues was revealed by Fluorescent in situ Hybridization and Scanning Electron Microscopy. The biofilm-forming ability of predominant bacterial isolates was studied via crystal violet assay and Confocal Laser Scanning Microscopy. The dominant phyla obtained from bacterial diversity analysis were Firmicutes, Proteobacteria, and Actinobacteria. The dominant aerobic pathogens identified by culture method are Pseudomonas, Proteus, Enterococcus, and Staphylococcus, whereas high-throughput sequencing revealed heightened levels of Streptococcus and Corynebacterium along with 22 different obligate anaerobes. The biofilm occurrence in chronic diabetic ulcer infection is well analysed. Herein, we illustrate the comprehensive pattern of bacterial infection and identify the community composition of chronic wound pathogenic biofilm.

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The role of anaerobes in diabetic foot infections

Cited by 79 publications

References 58 publications

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Remission in diabetic foot infections: Duration of antibiotic therapy and other possible associated factors

Study Protocol: Optimization of the surgical and medical management of diabetic foot infections

Metataxonomic approach to decipher the polymicrobial burden in diabetic foot ulcer and its biofilm mode of infection

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