J Korean Foot Ankle Soc.  2009 Dec;13(2):150-155.

Microbiology and Antibiotic Selection for Diabetic Foot Infections

Affiliations
  • 1Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea. yrrtyr@naver.com

Abstract

PURPOSE
To help the empirical antibiotics selection in diabetic foot infection patients, we investigated prevalence of microorganisms and their antibiotics sensitivity results.
MATERIALS AND METHODS
Patients who came to our clinics to treat diabetic foot infections with deep ulceration and were followed up more than 6 months until complete recovery were adopted. From March 2006 to June 2009, there were 140 patients who corresponded with such a inclusion criteria. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Microorganisms which was documented by wound culture and most susceptible antibiotics by minimum inhibitory concentrations were surveyed retrospectively.
RESULTS
Microorganisms were confirmed in 113 cases (80.7%). In the other 27 cases (19.3%), there were no cultured microorganisms. In bacterial growth group, there were 72 cases (63.7%) of gram-positive bacteria and 41 cases (36.3%) of gramnegative bacteria. All of them were aerobic microorganisms and there were no anaerobic microorganisms. Methicillin-sensitive staphylococcus aureus was the most common pathogen and accounted for 35 cases (31.0%). As other common pathogens, there were Enterobacter cloacae (11 cases, 9.7%), pseudomonas aeruginosa (10 cases, 8.8%), Methicillin-resistant staphylococcus aureus (10 cases, 8.8%) and enterococcus faecalis (6 cases, 5.3%), and so on. Common susceptible antibiotics in gram positive microorganism were vancomycin (60 cases, 83.3%), teicoplanin (60 cases, 83.3%), nitrofurantoin (60 cases, 83.3%) and ciprofloxacin (53 cases, 73.6%). In gram negative ones, common susceptible antibiotics were imipenem (35 cases, 85.3%), piperacillin/tazobactam (33 cases, 80.5%) and gentamicin (31 cases, 75.6%).
CONCLUSION
Methicillin-sensitive Staphylococcus aureus in gram positive and enterobacter cloacae in gram negative was the most common pathogen in each group. Ciprofloxacin and gentamicin might be adaptable as a first-line empirical antibiotics in infected diabetic foot patients.

Keyword

Foot; Infected diabetic foot; Empirical antibiotics; Wound culture; Minimum inhibitory concentration

MeSH Terms

Anti-Bacterial Agents
Bacteria
Ciprofloxacin
Diabetic Foot
Enterobacter cloacae
Enterococcus faecalis
Foot
Gentamicins
Gram-Positive Bacteria
Humans
Imipenem
Methicillin Resistance
Microbial Sensitivity Tests
Nitrofurantoin
Porphyrins
Prevalence
Pseudomonas aeruginosa
Staphylococcus aureus
Teicoplanin
Ulcer
Vancomycin
Anti-Bacterial Agents
Ciprofloxacin
Gentamicins
Imipenem
Nitrofurantoin
Porphyrins
Teicoplanin
Vancomycin
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