Authors
Zemlyanoj A.B.1, Zelenina T.A.2, Saluhov V.V.2
1 Pirogov National Medical and Surgical Center, Moscow
2 S.M. Kirov Military Medical Academy, Saint Petersburg
Abstract
Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.
Materials and methods. We included 62 type 2 diabetic inpatients (group 1) (38 male and 24 female) with severe foot infection in to the study. 102 diabetic foot outpatients (group 2) (56 male and 46 female) with postoperative wounds, who had been operated on and discharged from the hospital, were included in to the study too.
The complex of clinical and laboratory-instrumental examinations and treatment of the postoperative wounds according to the international standards were performed. Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.
Results. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. The role of Enterobacteriaceae increased with duration of infection. The prevalence of multidrug resistant Enterobacteriaceae makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.
Conclusion. The microbial load characterized by the presence of Gram-positive and Gram-negative pathogens after surgical debridement of acute infection at the inpatient stage of treatment. However, Grame-positive microorganisms predominated significantly (Staphylococcus aureus). The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gram-negative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment.
Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.
Keywords: diabetes mellitus, diabetic foot syndrome, multidrug resistant microorganisms, postoperative wounds healing.
References
1. Animaw W, Seyoum Y. Increasing prevalence of diabetes mellitus in a developing country and its related factors. PLoS One. 2017; 12(11): e0187670. doi:10.1371/journal.pone.0187670.
2. Singh N, Armstrong DG, Lipsky BA Preventing foot ulcers in patients with diabetes. JAMA 2005, 293: 217–228.
3. Boulton AJM, Armstrong DG, Kirsner RS, et al. Diagnosis and Management of Diabetic Foot Complications. Arlington, Va., American Diabetes Association, 2018, Р.20.
4. Lipsky, BA, Senneville, É, Abbas, ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36(S1): e3280. doi:org/10.1002/dmrr.3280.
5. Ndosi M, Wright-Hughes A, Brown S. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study Diabet. Med. 2018; (35): 78–88.
6. Weledji EP, Fokam P. Treatment of the diabetic foot — to amputate or not? BMC Surg. 2014; 14: 83. doi:10.1186/1471-2482-14-83.
7. Quilici MT, Del Fiol Fde S, Vieira AE, Toledo MI. Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection. J Diabetes Res. 2016: 8931508. doi:10.1155/2016/8931508.
8. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014, Atlanta, GA: US Department of Health and Human Services; 2014. URL.
9. Murphy-Lavoie HM, Ramsey A, Nguyen M, et al. Diabetic Foot Infections. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
10. Fortington LV, Geertzen JHB, van Netten JJ. Short and Long Term Mortality Rates after a Lower Limb Amputation European Journal of Vascular and Endovascular Surgery. 2013; 46 (1): 124–13.
11. Gardner SE, Hillis SL, Heilmann K, Segre JA, Grice EA. The neuropathic diabetic foot ulcer microbiome is associated with clinical factors. Diabetes. 2013; 62: 923–930.
12. Ramakant P, Verma AK, Misra R et al. 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.
13. Bader M, Jafri AK, Krueger T, Kumar V. Fusarium osteomyelitis of the foot in a patient with diabetes mellitus. Scand J Infect Dis. 2003; 35: 895–896.
14. Boyanova L, Mitov I. Antibiotic resistance rates in causative agents of infections in diabetic patients: rising concerns. Expert Rev Anti Infect Ther. 2013; 11: 411–420.
15. Ozer B, Kalaci A, Semerci E, Duran N, Davul S, Yanat AN. Infections and aerobic bacterial pathogens in diabetic foot. Afr J Microbiol Res. 2010; 4: 2153–2160.
16. Djahmi N, Messad N, Nedjai S, et al. Molecular epidemiology of Staphylococcus aureus strains isolated from inpatients with infected diabetic foot ulcers in an Algerian University Hospital. Clin Microbiol Infect. 2013; 19: E398–404. 46.
17. Byren I, Peters EJ, Hoey C, Berendt A, Lipsky BA. Pharmacotherapy of diabetic foot osteomyelitis. Expert Opin Pharmacother. 2009; 10:3033–3047.
