Silver dressing in the treatment of diabetic foot: A protocol for systematic review and meta-analysis.

Background To investigate the distribution of microbes and drug susceptibility in patients with diabetic foot infections (DFI) and provide guidance for clinical empirical treatment and the rational selection of antibacterial drugs. Methods Retrospective analysis of the pathogenic bacterium distribution and antimicrobial susceptibility isolated from 581 DFI patients with different Wagner grades. Results The 534 positive samples included 473 cases (88.58%)) of monomicrobial infections and 61 cases (11.42%) of polymicrobial infections before antibiotic therapy. A total of 656 strains were cultivated, including 387 (58.99%) strains of gram-positive organisms (GPOs), 235 (35.82%) gram-negative bacilli (GNB), and 21 (3.20%) fungal strains. Polymicrobial infections mainly occurred in patients with Wagner grade 3-4 ulcers. GPOs were predominant in Wagner grades 1-3 (grade 1: 96.67%, grade 2: 76.52%, grade 3 62.81%), and the most common was Staphylococcus aureus (grade 1: 31.66%, grade 2: 33.04%, grade 3 35.53%). GNB were predominant in grades 4-5 (grade 4: 51.46%, grade 5:60%), and the most common GNB in Wagner grades 4-5 was Proteus (grade 4:27.88%, grade 5: 42.86%), while the most common GPO was Enterococcus (grade 4:34.48%, grade 5:25.00%). Staphylococcus (including MRSA) and Enterococcus were still highly sensitive to vancomycin, linezolid, and tigecycline. Most GNB were still highly sensitive to meropenem, tigecycline, ertapenem, and amikacin. Proteus was most sensitive to amikacin (97.14%), followed by meropenem (92%) and ertapenem (80%). Conclusion The distribution of microbes and antimicrobial susceptibility in DFI patients varied with different Wagner grades. The most appropriate antimicrobial therapy should be selected based on the pathogen culture and antimicrobial susceptibility.

/pdf/distribution-of-microbes-and-antimicrobial-susceptibility-in-35arsoct.pdf

Distribution of microbes and antimicrobial susceptibility in patients with diabetic foot infections in South China

Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection. Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n = 10), grade 3 (n = 29), and grade 4 (n = 17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen. Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p = 0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such as E. coli and Citrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such as Serratia and Ralstonia pickettii, were isolated from deep tissues but not from swabs. Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria.

/pdf/a-comparison-of-tissue-versus-swab-culturing-of-infected-3s57fht66h.pdf

A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds.

Objective
To explore the microbiological profiles and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers so as to provide selection rationales of antibiotics.


Methods
A retrospective study was conducted on the microbiological profiles and antibiotic susceptibilities in 754 strains of pathogens isolated from 519 patients with diabetic foot ulcers at our hospital from January 2010 to August 2013. The inter-group data were compared by Chi-square test.


Results
There were 322 (62.0%) males and 197 (38.0%) females. Their mean age was (67.7±12.3) (30-93) years, duration of diabetes 10 (0-40) years, duration of lower-limb lesion 1.0 (0.0-72.0) months and HbA1c (9.09%±2.28%). Among 444 (85.5%) cases, a total of 754 strains of pathogens were isolated. Gram-positive aerobes were the most frequently isolated (47.3%, 357 strains) and followed by gram-negative aerobes and fungus (40.3% vs 12.3%, 304 vs 93 strains respectively). With rising Wagner′s grades, bacterial floras transformed from Gram-positive cocci to Gram-negative rods while fungus and composite infections increased. And 122 strains were of multi drug resistant organisms (MDRO). Among 357 strains of Gram-positive bacteria, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis were dominating floras. Staphylococcus was highly resistant to penicillin G, erythromycin, and oxacillin while vancomycin and linezolid were the most effective agents against gram-positive bacteria. Among 304 strains of gram-negative bacteria, enterobacteria were the most prevalent, including 48 strains of Escherichia coli, 34 strains of Proteus mirabilis and 31 strains of Proteus vulgaris. And there were 29 strains of Pseudomonas aeruginosa. Enterobacteria were highly resistant to ampicillin, followed by bactrim and furadantin while meropenem, imipenem, piperacillin/sulbactam, sulperazone and cefepime were the most effective agents. The predominant fungus was Blastomyces albicans.


Conclusions
In patients with severe diabetic foot ulcers, Gram-negative rods predominate while the prevalence of fungus and composite infections increases. Vancomycin and imipenem maintain highly antibacterial activity. It is essential to pay attention to pathogen survey and use antibiotics more rationally.


Key words: 
Diabetic foot; Infection; Microbial; Drug resistance

Clinical distribution and antimicrobial resistance analysis of 754 pathogenic bacteria in diabetic foot infection

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Clinical distribution and antimicrobial resistance analysis of 754 pathogenic bacteria in diabetic foot infection