Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.7)
Index Copernicus  – 161.11; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 1, January-February, p. 39–48

Publication type: original article

Language: English

Etiological Factors of Infections in Diabetic Foot Syndrome – Attempt to Define Optimal Empirical Therapy

Rafał Małecki1,A,B,D, Krzysztof Rosiński2,B,D, Rajmund Adamiec1,C,E,F

1 Department of Angiology, Systemic Hypertension and Diabetology, Wroclaw Medical University, Poland

2 Students’ Scientific Group at the Department of Angiology, Systemic Hypertension and Diabetology, Wroclaw Medical University, Poland

Abstract

Background. Diabetic foot syndrome (DFS) represents one of the most frequent reasons for lower limb amputation in developed countries. In most cases, it is associated with bacterial infection, requiring optimal antibiotic therapy.
Objectives. The aim of this study was to identify the most frequent pathogens responsible for infections associated with DFS, establish the optimal protocol of empirical therapy, and ascertain the clinical variables that may determine the choice of the appropriate antibacterial agent.
Material and Methods. The analysis included hospital records of patients treated at the Department between 2008 and 2010. A total of 102 individuals were identified; their material was cultured and tested for antibiotic susceptibility.
Results. A total of 199 bacterial strains were isolated. There was a predominance of Gram-positive bacteria, particularly Staphylococcus aureus, Staphylococcus coagulase-negative strains, and Enterococcus faecalis. Of note was the high percentage of E. faecalis infection (16.08%). One can speculate on the potential etiological factors in the case of some bacteria, e.g. patients infected with S. aureus were characterized by higher monocytosis and lymphocytosis as compared to other patients. Analysis of drug susceptibility revealed that ciprofloxacin has the highest (but still only 44%) efficacy of all agents tested as monotherapy, and a combination of piperacillin and tazobactam or amoxicillin and clavulanate with aminoglycosides is particularly beneficial.
Conclusion. Staphylococcus spp. predominates amongst the etiological factors of DFS infection; however, the rate of E. faecalis infection is alarmingly high. Monotherapy enables effective treatment in a minority of cases; therefore, at least two-drug protocols should be implemented from the very beginning of the therapy.

Key words

antibiogram-based therapy, antibiotics, diabetic foot syndrome, Enterococcus faecalis.

References (21)

  1. IDF Atlas: http://www.idf.org/atlasmap/atlasmap, 2011.
  2. Polskie Towarzystwo Diabetologiczne: Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2011. Diabet Prakt 2011, 5 (supl. A), A33.
  3. Korzon-Burakowska A: Zespół stopy cukrzycowej – patogeneza i praktyczne sposoby postępowania. Choroby serca i naczyń 2007, 4, 93–98.
  4. Shah BR, Hux JE: Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 2003, 26, 510–513.
  5. Yekta Z, Pourali R, Nezhadrahim R, Ravanyar L, Ghasemi-Rad M: Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer. Diabetes Metab Syndr Obes 2011, 4, 371–375.
  6. Rozporządzenie Ministra Zdrowia z dnia 23 grudnia 2011 r. w sprawie listy czynników alarmowych, rejestrów zakażeń szpitalnych i czynników alarmowych oraz raportów o bieżącej sytuacji epidemiologicznej szpitala. Dziennik Ustaw 2011, 294, 17195–17205.
  7. Prompers L, Huijberts M, Apelqvist J: High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 2007, 50, 18–25.
  8. Dang CN, Prasad YD, Boulton AJ, Jude EB: Methicillin resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003, 20, 159–161.
  9. Citron DM, Goldstein EJC, Merriam CV, Lipsky BA, Abramson MA: Bacteriology of moderate to severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 2007, 45, 2819–2828.
  10. Ramakant P, Verma AK, Misra R: Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia 2011, 54, 58–64.
  11. Crouzet J, Lavigne JP, Richard JL: Diabetic foot infection: a critical review of recent randomized clinical trials on antibiotic therapy. Int J Infect Dis 2011, 15, e601–e610.
  12. Sebeena M, Boopathy T: Enterococcus faecalis – an endodontic challenge. J Indian Acad Dent Spec 2010, 1, 46–48.
  13. Poulsen LL, Bisgaard M, Son NT, Trung NV, An HM, Dalsgaard A: Enterococcus faecalis Clones in Poultry and in Humans with Urinary Tract Infections, Vietnam. Emerg Infect Dis 2012, 18, 1096–1100.
  14. Salem-Bekhit MM, Moussa IMI, Muharram MM, Alanazy FK, Hefni HM: Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens. Indian J Med Microbiol 2012, 30, 44–51.
  15. Vinodkumar CS, Srinivasa H, Basavarajappa KG, Geethalakshmi S, Bandekar N: Isolation of bacteriophages to multi-drug resistant Enterococci obtained from diabetic foot: A novel antimicrobial agent waiting in the shelf? Indian J Pathol Microbiol 2011, 54, 90–95.
  16. Mendiratta DK, Kaur H, Deotale V, Thamke DC, Narang R, Narang P: Status of high level aminoglycoside resistant Enterococcus faecium and Enterococcus faecalis in a rural hospital of central India. Indian J Med Microbiol 2008, 26, 369–371.
  17. Rudy M, Zientara M, Bek T, Martirosian G: Occurrence of Antibiotic Resistant Enterococci in Clinical Specimens from a Pediatric Hospital. Pol J Microbiol 2005, 54, 77–80.
  18. Bożek J, Jaeschke R, Leśniak W: Ocena informacji o metodzie diagnostycznej. In: Podstawy EBM, czyli medycyny opartej na danych naukowych dla lekarzy i studentów medycyny. Eds.: Gajewski P, Jaeschke R, Brożek J. Med Prakt, Kraków 2008, 1st ed., 102–104.
  19. Sava IG, Heikens E, Huebner J: Pathogenesis and immunity in enterococcal infections. Clin Microbiol Infect 2010, 16, 533–540.
  20. Takahashi H, Tsuda Y, Takeuchi D, Kobayashi M, Herndon DN, Suzuki F: Influence of systemic inflammatory response syndrome on host resistance against bacterial infections. Crit Care Med 2004, 32, 1879–1885.
  21. Dzierżanowska D, Dzierżanowska-Fangrat K: Przewodnik antybiotykoterapii 2011. Alfa-Medica Press, Bielsko-Biała 2011.
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