Diabetic foot: infections and outcomes in Iranian admitted patients
Azar Hadadi1, Houra Omdeh Ghiasi2, Mahboubeh Hajiabdolbaghi3
1Department of Internal Medicine, Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, IR Iran.
Background:
Diabetes mellitus (along with its complications) has become a global problem. Diabetic foot infection, among the most common complications, is responsible for 40 to 50% of foot amputations. Antibiotic-resistant microorganisms, however, have compromised empiric therapy in the infected patients.
Objectives:
The current study aimed to determine the most common microorganisms involved in diabetic foot infection in order to minimize the failure of antibiotic therapy and the risk of developing complications.
Patients And Methods:
All patients with diabetic foot infection admitted to the infectious diseases, surgery and endocrinology wards of two teaching hospitals from 2007 to 2010 (n = 196) were recruited. In this retrospective study, demographic characteristics, type of lesions, history of hospitalization/antibiotic therapy, isolated microorganisms, clinical complications, administered treatment (medical or surgical) and outcome were recorded.
Results:
Patients' mean age was 60.84 (± 10.30) years. Totally, 113 (57.65%) of the patients were male and 83 (42.35%) were female. According to Wagner's grading, deep ulcers with/without osteomyelitis accounted for the majority of lesions. A single microorganism was isolated (most common: Escherichia coli, Staphylococcus aureus and Klebsiella spp.) from 81 of the patients (80.20%); while for the remaining polymicrobial infection was reported. Isolated pathogens showed no significant correlation with duration of diabetes, type of the lesions (P = 0.13) and history of hospitalization (P = 0.61). The majority of patients (n = 118, 60.20%) were treated surgically; however 11 patients expired due to sepsis. Amputation (most common at toes and below the knee) was performed for 89 patients (45.40%). The response rate to medical treatment was 31.6% for single-pathogen and 10% for polymicrobial infection (with a 30% mortality rate).
Conclusions:
Physicians are recommended to take microbiological cultures before starting empirical therapy recommended to cover Gram-negative microorganisms in order to lower the risk of antibiotic resistance.
Insights
Diabetic foot infections are a major cause of amputations, with antibiotic resistance a growing concern. This study identified common pathogens like Escherichia coli and Staphylococcus aureus, recommending pre-treatment cultures to guide therapy and reduce complications.
Area of Science:
- Infectious Diseases
- Endocrinology
- Surgery
Background:
- Diabetes mellitus and its complications pose a global health challenge.
- Diabetic foot infections are a leading cause of lower limb amputations.
- Rising antibiotic resistance complicates the treatment of diabetic foot infections.
Purpose of the Study:
- To identify prevalent microorganisms in diabetic foot infections.
- To inform empirical antibiotic therapy choices.
- To reduce treatment failure and amputation rates.
Main Methods:
- Retrospective analysis of 196 patients with diabetic foot infections (2007-2010).
- Data collected included demographics, lesion type, treatment, and outcomes.
- Microbiological cultures were used to identify causative pathogens.
Main Results:
- Common isolates included Escherichia coli, Staphylococcus aureus, and Klebsiella spp.
- Polymicrobial infections were frequent.
- Surgical treatment was common (60.20%), with high amputation rates (45.40%).
- Medical treatment response was poor for polymicrobial infections (10% response, 30% mortality).
Conclusions:
- Empirical antibiotic therapy should cover Gram-negative microorganisms.
- Microbiological cultures are crucial before initiating treatment.
- Targeted therapy can mitigate antibiotic resistance and improve outcomes.
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