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[Highly resistant pathogens in patients with diabetic foot syndrome with special reference to methicillin-resistant
A Wagner1, H Reike, B Angelkort
1Abteilung für Innere Medizin, Marien Hospital Dortmund. dr.wagner@marien-hospital-dortmund.de
Background And Objective:
Patients with diabetic foot infection (DFI) have a high rate of infection, up to 40%, with methicillin-resistant Staph. aureus (MRSA). Having noticed a definite increase of such patients in our special unit, we initiated a drastic change of hygienic measures and here report the results.
Patients And Methods:
788 patients with DFI (mean age 67.3 [32-90] years, 62% males) were admitted between 1.1.1999 and 31.7.2000. Before 31.7.1999, the following hygienic measures had been in place: cohort isolation, protective closing, implementation of general hygienic rules. Since 1.8.1999, modified measures have been undertaken: primary single-patient isolation, concentration in one ward of all patients with MRSA, medical care only by trained personnel, admission of patients only after microbiological results were known or primary solitary isolation. Algorithms were used for the transmission of all necessary information.
Results:
MRSA was demonstrated in 64 patients. The number of infections during the hospital stay, before and after the change of hygienic measures were 9 (27%) and 2 patients (8%), respectively. The sites of MRSA colonisation and proven eradication were: nasopharynx only, 3 with 67% eradication; MRSA in a wound, 25 with 28% eradication. In comparison to the yearly statistic on wound healing in DFI 1999 (n=613) the following results are shown (patients with MRSA in brackets): healing rate with conservative treatment 61.5% (20%), minor-amputation 30.5% (52%), major-amputation 4.5% (22%), death 3.5% (6%).
Conclusions:
The rate of new infections were dramatically reduced by changing the hygienic measures. The rate of successful sanitation was unsatisfactoy. Patients with MRSA showed markedly poorer treatment results in respect to wound healing.
Insights
Implementing enhanced hygienic measures significantly reduced new methicillin-resistant Staph. aureus (MRSA) infections in diabetic foot infection (DFI) patients. However, MRSA eradication rates were low, and patients with MRSA experienced poorer wound healing outcomes.
Area of Science:
- Infectious Diseases
- Hospital Hygiene
- Diabetic Foot Care
Context:
- Diabetic foot infections (DFI) present a high risk of methicillin-resistant Staph. aureus (MRSA) colonization and infection, affecting up to 40% of patients.
- A notable increase in MRSA-infected DFI patients prompted a review and modification of existing hygiene protocols within a specialized unit.
Purpose:
- To evaluate the impact of revised hygienic measures on the incidence of new MRSA infections among DFI patients.
- To assess the effectiveness of MRSA eradication strategies and analyze treatment outcomes in DFI patients, particularly those with MRSA.
Summary:
- A study involving 788 DFI patients (1999-2000) compared outcomes before and after implementing stricter hygiene protocols, including single-patient isolation and dedicated MRSA wards.
- The revised measures led to a significant reduction in new MRSA infections, from 27% to 8%.
- Despite reduced new infections, MRSA eradication rates were unsatisfactory (e.g., 28% for wound MRSA), and patients with MRSA had significantly worse outcomes, including lower healing rates and higher amputation rates.
Impact:
- The study demonstrates that enhanced hygiene protocols can dramatically decrease the rate of new MRSA infections in vulnerable DFI patient populations.
- The findings highlight the persistent challenge of MRSA eradication and underscore the poorer prognoses for DFI patients with MRSA, necessitating further research into effective treatment and sanitation strategies.