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2021, Number 3

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Revista Cubana de Angiología y Cirugía Vascular 2021; 22 (3)

Microbiologic characteristics of patients with diabetic foot ulceration

Febles SRJ, Albelo LY, Castañeira JE, García HAL, González LAM, Aldama FA

Language: Spanish
References: 44
Page: 1-25
PDF size: 344.14 Kb.


ABSTRACT

Introduction: Diabetic foot ulcer infections are common, complex, high cost and are the leading cause of non-traumatic lower extremity amputation.
Objective: To identify the microorganisms isolated to estimate both the sensitivity to antibiotics and the coincidence between empirical treatment and microbiological results in patients with diabetic foot ulcers.
Methods: A descriptive-retrospective investigation was performed. The study population consisted of 210 patients admitted to the University Hospital "Comandante Faustino Pérez Hernández" of Matanzas between June 2017 and June 2020. The output variables were the frequency and type of germ, the number of germs per ulcer, the sensitivity for each type of antibiotic, and the percentage of coincidence between the empirical treatment and the microbiological result.
Results: A total of 259 germs were identified and 1.23 germs per ulcer were observed. The 62.5% of the germs found were Gram negative, but the most represented germ was Staphylococcus aureus. Of the Staphylococcus aureus, 58.8% were resistant to methicillin. Vancomycin and linezolid were effective in 100% of Gram positives. Amikacin was the most effective antibiotic for Gram-negatives. Agreement between empirical treatment and antibiogram result was observed in 27.6% of patients.
Conclusions: An appropriate microbiological diagnosis of diabetic foot ulcers is necessary to identify the germs present in the lesions and to design adequate antimicrobial therapy algorithms.


REFERENCES

  1. Blanes JI, Clará A, Lozano F, Alcalá D, Doiz E, Merino R, et al. Documento de consenso sobre el tratamiento de las infecciones en el pie diabético. Rev Esp Quimioter. 2011 [acceso 28/05/2021];24(4):233-62. Disponible en: Disponible en: https://www.elsevier.es/es-revista-angiologia-294-articulo-documento-consenso-sobre-el-tratamiento-S0003317011001556

  2. Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg. 2003;186:44S-54S. DOI: https://doi.org/10.1016/j.amjsurg.2003.10.008

  3. Al Benwan K, All Mullah A, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. Journal of Infection and Public Health. 2012(5):1-8. DOI: https://doi.org/10.1016/j.jiph.2011.07.004

  4. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004(39):885-910. DOI: https://doi.org/10.1086/424846

  5. Schaper NC, Apelqvist J, Bakker K. International Working Group on the Diabetic Foot. International consensus on the diabetic foot (CD-ROM). Current Diabetes Reports. 2004;3(6):475-9. DOI: https://doi.org/10.1007/s11892-003-0010-4

  6. Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect Dis. 2007;44:562-5. DOI: https://doi.org/10.1086/511036

  7. Llop A, Valdez M, Zuazo J. Microbiología y Parasitología Médica. 2009 [acceso 13/05/2021]. Disponible en: Disponible en: https://articulos.sld.cu/ecimed/category/parasitologia/

  8. World Medical Association (WMA). Declaration of Helsinki. Ethical principles for medical research involving human subjects. 64th WMA General Assembly. Fortaleza, Brasil; 2013. DOI: https://doi.org/10.1001/jama.2013.281053

  9. Anuario estadístico de salud 2019. Ministerio de Salud Pública. Dirección de registros médicos y estadísticas de salud. La Habana; 2020 [acceso 13/05/2021]. Disponible en: Disponible en: http://bvscuba.sld.cu/anuario-estadistico-decuba/ .

  10. Peters EJ. Pitfalls in diagnosing diabetic foot infections. Diabetes Metab Res Rev. 2016;32(Supp 1):254-60. DOI: https://doi.org/10.1002/dmrr.2736.

  11. Pitocco D, Spanu T, Di Leo M, Vitiello R, Rizzi A, Tartaglione L, et al. Diabetic foot infections: a comprehensive overview. EurRevMedPharmacolSci. 2019 Apr;23(2 Suppl):26-37. DOI: https://doi.org/10.26355/eurrev_201904_17471

  12. Li X, Qi X, Yuan G, Ju S, Yu Z, Deng W, et al. Microbiological profile and clinical characteristics of diabetic foot infection in northern China: a retrospective multicentre survey in the Beijing area. J Med Microbiol. 2018 Feb;67(2):160-8. DOI: https://doi.org/10.1099/jmm.0.000658

  13. Uivaraseanu B, Bungau S, Tit DM, Fratila O, Rus M, Maghiar TA, et al. Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome. Medicina (Kaunas). 2020;56:380. DOI: https://doi.org/10.3390/medicina56080380

  14. Otta S, Debata NK, Swain B. Bacteriological profile of diabetic foot ulcers. CHRISMED J Health Res. 2019;6:7-11. DOI: https://doi.org/10.4103/cjhr.cjhr_117_17

  15. Hefni A, Ibrahim AR, Attia KM. Bacteriological study of diabetic foot infection in Egypt. J Arab Soc Med Res 2013;8:26-32. Disponible en: https://doi.org/10.7123/01.JASMR.0000429086.88718.bb

  16. Ozer B, Kalaci A, Semerci E, Duran N, Davul S, Yanat AN. Infections and aerobic bacterial pathogens in diabetic foot. African Journal of Microbiology Research. 2010 [acceso 10/04/2021];4(20):2153-60. Disponible en: Disponible en: http://www.academicjournals.org/ajmr

  17. Macdonald KE, Jordan CY, Crichton E, Barnes JE, Harkin GE, Hall LML, et al. A retrospective analysis of the microbiology of diabetic foot infections at a Scottish tertiary hospital. BMC Infectious Diseases. 2020;20:218. DOI: https://doi.org/10.1186/s12879-020-4923-1

  18. Ismail AA, Meheissen MA, AbdElaaty TA, Abd-Allatif NE, Kassab HS. Microbial profile, antimicrobial resistance and molecular characterization of diabetic foot infections in a university hospital. GERMS. 2021;11(1):39-51. DOI: https://doi.org/10.18683/germs.2021.1239

  19. Bello OO, Oyekanmi EO, Kelly BA, Mebude OO, Bello TK. Antibiotic susceptibility profiles of bacteria from diabetic foot infections in selected Teaching Hospitals in Southwestern Nigeria. Int Ann Sci. 2018;4:1-3. DOI: https://doi.org/10.21467/ias.4.1.1-13

  20. Kathirvel M, Prabakaran V, Jayarajan J, Sivakumar A, Govinda V. Risk factors for the diabetic foot infection with multidrug-resistant microorganisms in South India. IntSurg J. 2018;5:675-82. DOI: https://doi.org/10.18203/2349-2902.isj20180374

  21. Miyan Z, Fawwad A, Sabir R, Basit A. Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country. J Pak Med Assoc. 2017 [acceso 09/05/2021];67:665-9. Disponible en: Disponible en: https://jpma.org.pk/article-details/8182?article_id=8182

  22. Chiang Goh T, Yazid Bajuri M, Nadarajah SC, Abdul Rashid AH, Baharuddin S, Syariza Zamri K. Clinical and bacteriological profile of diabetic foot infections in a tertiary care. Journal of Foot and Ankle Research. 2020;13:36. DOI: https://doi.org/10.1186/s13047-020-00406-y

  23. 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. DOI: https://doi.org/10.1128/JCM.00551-07

  24. Seung Tae S, Seung-Kyu H, Tae Yul L, Sik N, Eun-Sang D. The Microbiology of Diabetic Foot Infections in Korea. J Wound Management Res. 2017 May;13(1):8-12. DOI: https://doi.org/10.22467/jwmr.2017.00108

  25. Choucair J, Saliba G, Chehata N, Nasnas R, Saad NR. Epidemiology of the diabetic foot infection in a tertiary care hospital in the Lebanon: a retrospective study between 2000 and 2011. J Infect Dis Ther. 2018;6:381. DOI: https://doi.org/10.4172/2332-0877.1000381

  26. Sánchez-Sánchez M, Cruz-Pulido WL, Bladinieres-Cámara E, Alcalá-Durán R, Rivera-Sánchez G, Bocanegra-García V. Bacterial Prevalence and Antibiotic Resistance in Clinical Isolates of Diabetic Foot Ulcers in the Northeast of Tamaulipas, Mexico. The International Journal of Lower Extremity Wounds 2017;16(2):129-34. DOI: https://doi.org/10.1177/15347346177052

  27. Xie X, Bao Y, Ni L, Liu D, Niu S, Lin H, et al. Bacterial Profile and Antibiotic Resistance in Patients with Diabetic Foot Ulcer in Guangzhou, Southern China: Focus on the Differences among Different Wagner’s Grades, IDSA/IWGDF Grades and Ulcer Types. International Journal of Endocrinology. 2017:12. DOI: https://doi.org/10.1155/2017/8694903

  28. Ogba OM, Nsan E, Eyam ES. Aerobic bacteria associated with diabetic foot ulcers and their susceptibility pattern. Biomed Dermatol. 2019;3:1. DOI: https://doi.org/10.1186/s41702-019-0039-x

  29. Lamia J, Rola FJ, Rakan N, Itani O, Fady H, NisrineRizk Jamal J. Microbiological profile and antimicrobial resistance among diabetic foot infections in Lebanon. Int Wound J. 2020;17:1764-73. DOI: https://doi.org/10.1111/iwj.13465

  30. Wu WX, Liu D, Wang YW, Wang C, Yang C, Liu XZ, et al. Empirical Antibiotic Treatment in Diabetic Foot Infection: A Study Focusing on the Culture and Antibiotic Sensitivity in a Population From Southern China. In J Low Extrem Wounds. 2017 Sep;16(3):173-82. DOI: https://doi.org/10.1177/1534734617725410

  31. Flores R, Cárcamo S, Pavón D, Avilés A, Díaz CM, Giacaman L, et al. Perfil bacteriológico en pacientes con pie diabético que asisten al Instituto Nacional del Diabético Tegucigalpa, Honduras, Enero 2013-Diciembre 2015. Archivos de Medicina. 2016;12(3):12. DOI: https://doi.org/10.3823/1311

  32. Yovera-Aldana M, Rodríguez A, Vargas M, Heredia P, Huamán MO, Vargas-Vilca J, et al. Resistencia bacteriana y factores asociados en pacientes con pie diabético infectado sin desenlace de amputación mayor en un hospital nacional peruano. Acta Med Perú. 2017;34(3):173-81. DOI: https://doi.org/10.35663/amp.2017.343.396

  33. Saseedharan S, Sahub M, Chaddhaa MR, Pathrosea E, Balc A, Bhalekarc P, et al. Epidemiology of diabetic foot infections in a reference tertiary hospital in India. bjmicrobiol. 2018;49:401-6. DOI: https://doi.org/10.1016/j.bjm.2017.09.003

  34. Nikaido H. Multidrug Resistance in Bacteria. Annu Rev Biochem. 2009;78:119-46. DOI: https://doi.org/10.1146/annurev.biochem.78.082907.145923

  35. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81. DOI: https://doi.org/10.1111/j.1469-0691.2011.03570.x

  36. Susanti I, Arianto B, Purnamayanti A. Antibiotics Efficacy Analysis on Diabetic Foot Ulcer Inpatients. Int. J. Pharm. Med. Biol. Sci. 2016;5:232-6. DOI: https://doi.org/10.18178/ijpmbs.5.4.232-236

  37. Anette P, Krishna Kumar K, Panayappan L, Mathew L. Diabetic foot infection and its management: A review GSC. Biological and Pharmaceutical Sciences. 2018;4(1):19-24. Disponible en: https://doi.org/10.30574/gscbps.2018.4.1.0041

  38. Barwell ND, Devers MC, Kennon B, Hopkinson HE, McDougall C, Young MJ, et al. On behalf of the Scottish Diabetes Foot Action Group. Diabetic foot infection: Antibiotic therapy and good practice recommendations. Int J Clin Pract. 2017:e13006. DOI: https://doi.org/10.1111/ijcp.13006

  39. Abbas M, Uckay I, Lipsky BA. In diabetic foot infections antibiotics are to treat infection, not to heal wounds. Expert Opin. Pharmacother. 2015;16(6). DOI: https://doi.org/10.1517/14656566.2015.1021780

  40. Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, Embil JM, et al. On behalf of the International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(S1):e3280. Disponible en: https://doi.org/10.1002/dmrr.3280

  41. Sekhar MS, Unnikrishnan MK, Sunil G, Vyas N, Mukhopadhyay C. Antimicrobial susceptibility pattern of aerobes in diabetic foot ulcers in a South-Indian tertiary care hospital. Foot (Edinb). 2018;37:95-100. DOI: https://doi.org/10.1016/j.foot.2018.07.002

  42. Kaimkhani GM, Siddiqui AA, Rasheed N, Rajput MI, Kumar J, Khan MH, et al. Pattern of Infecting Microorganisms and their susceptibility to antimicrobial drugs in patients with diabetic foot infections in a tertiary care Hospital in Karachi, Pakistan. Cureus. 2018;10:e2872. DOI: https://doi.org/10.7759/cureus.2872

  43. Ahmadishooli A, Davoodian P, Shoja S, Ahmadishooli B, Dadvand H, Hamadiyan H, et al. Frequency and Antimicrobial Susceptibility Patterns of Diabetic Foot Infection of Patients from Bandar Abbas District. Southern Iran. J Pathog. 2020. DOI: https://doi.org/10.1155/2020/1057167

  44. Boulton A, Armstrong DG, Hardman MJ, Embil JM, Attinger ChE, Lipsky BA, et al. Diagnosis and Management of Diabetic Foot Infection. American Diabetes Association. 2020 [acceso 25/05/2021]. Disponible en: Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK554227/




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