Wound Chronicity, Inpatient Care, and Chronic Kidney Disease Predispose to MRSA Infection in Diabetic Foot Ulcers

Abstract

OBJECTIVETo determine the microbiological profile of diabetes-related foot infections (DRFIs) and the impact of wound duration, inpatient treatment, and chronic kidney disease (CKD).RESEARCH DESIGN AND METHODSPostdebridement microbiological samples were collected from individuals presenting with DRFIs from 1 January 2005 to 31 December 2007.RESULTSA total of 653 specimens were collected from 379 individuals with 36% identifying only one isolate. Of the total isolates, 77% were gram-positive bacteria (staphylococci 43%, streptococci 13%). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 23%; risk factors for MRSA included prolonged wound duration (odds ratio 2.31), inpatient management (2.19), and CKD (OR 1.49). Gram-negative infections were more prevalent with inpatient management (P = 0.002) and prolonged wound duration (P < 0.001). Pseudomonal isolates were more common in chronic wounds (P < 0.001).CONCLUSIONSDRFIs are predominantly due to gram-positive aerobes but are usually polymicrobial and increase in complexity with inpatient care and ulcer duration. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered.

Bacteriological Profile and their Antibiotic Susceptibility Pattern in Diabetic Foot Ulcers in a Tertiary Care Hospital, Puducherry, India

“…In our study, we observed, 21% of Staphylococcus aureus isolates were resistant to Methicillin, which is in accordance with the results of the study conducted by Yates et al, 2009. In this study, Pseudomonas aeruginosa were highly sensitive to piperacillin tazobactam (93.3%), followed by imipenem, (86.7%) and ceftazidime (66.6%), amikacin (66.6%), ciprofloxacin (66.6%). Sensitivity pattern on Pseudomonas correlated with the other studies (Bansal et al, 2008;Sekhar et al, 2014).…”

Insulin Treatment Directly Restores Neutrophil Phagocytosis and Bactericidal Activity in Diabetic Mice and Thereby Improves Surgical Site Staphylococcus aureus Infection

“…Foot infections following skin ulceration are also common causes of hospitalization for diabetic patients (6). These infectious complications seriously impair prognoses for diabetic patients (44).…”

“…Especially, Staphylococcus aureus is a major pathogen in these infections (44). Methicillin-resistant S. aureus (MRSA) also has become prevalent among both nosocomial and community-acquired infections in diabetic patients (44).…”

Clonal distribution and possible microevolution of methicillin-resistant Staphylococcus aureus strains in a teaching hospital in Malaysia

“…The elderly had been reported to have worse prognosis when infected due to immobility, poor nutrition and prior exposure to antibiotics [21,22] . Studies have also shown that patients with these underlying diseases were prone to MRSA infections [23][24][25] . Diabetic patients possess higher risk because it is likely for them to develop complications, such as foot ulcers, that predispose them to infections [26] .…”