Pseudomonal Diabetic Foot Infections: Vive la Différence?
Ilker Uçkay1,2,3, Dan Lebowitz2, Benjamin Kressmann1
1Clinical Pathway for Diabetic Foot Infections, Geneva University Hospitals, Geneva, Switzerland.
Objective:
To assess the outcomes of diabetic foot infections (DFIs) due to Pseudomonas aeruginosa.
Patients And Methods:
From April 24, 2013 to July 31, 2016, we analyzed data from patients prospectively enrolled in our clinical pathway of DFIs, comparing those with infection due to Pseudomonas with those without infection due to Pseudomonas.
Results:
Overall, we assessed 1018 cases of DFIs: 392 with osteomyelitis and 626 with only soft tissue infections. The prevalence of P aeruginosa in deep wound cultures was 10% (104/1018); of the 1018 cultures, 22 were monomicrobial, 82 were polymicrobial, and 46 were with osteomyelitis. Overall, the patients were treated with a median of 1 surgical debridement and a total of 20 days of antibiotic therapy. In a comparison of crude groups, the proportion of clinical failures was significantly higher with Pseudomonas than with other pathogens (36/104 [35%] vs 218/914 [24%], respectively; P=.02). A multivariate analysis showed that pseudomonal DFIs did not recur more often than nonpseudomonal DFIs (hazard ratio, 1.0; 95% confidence interval, 0.6-1.7). Among the 104 cases of pseudomonal DFIs, there was no association between failure of treatment and the total duration of antibiotic therapy, duration of intravenous therapy, duration of combined antibiotic therapy with more than 1 agent, or duration of oral (fluoroquinolone) therapy. Among 15 cases of pseudomonal recurrence, 2 (13%) developed resistance to the antibiotic agent used for the index episode.
Conclusion:
For DFIs caused by P aeruginosa, other than choosing an antibiotic agent that is active against the organism, it does not appear necessary to treat with a different therapeutic regimen compared with the treatment of nonpseudomonal DFIs. There is no difference!
Insights
Diabetic foot infections (DFIs) caused by Pseudomonas aeruginosa show higher initial failure rates but similar recurrence compared to other pathogens. Treatment regimens for pseudomonal DFIs do not need to differ from nonpseudomonal DFIs, focusing on active antibiotic selection.
Area of Science:
- Infectious Diseases
- Diabetology
- Microbiology
Background:
- Diabetic foot infections (DFIs) are a significant complication of diabetes mellitus.
- Pseudomonas aeruginosa is a common pathogen in DFIs, potentially impacting treatment outcomes.
Purpose of the Study:
- To assess the clinical outcomes of DFIs specifically caused by Pseudomonas aeruginosa.
- To compare the treatment response and recurrence rates of pseudomonal DFIs versus nonpseudomonal DFIs.
Main Methods:
- Prospective analysis of 1018 DFI cases from April 2013 to July 2016.
- Comparison of outcomes between patients with Pseudomonas infections and those with other pathogens.
- Inclusion of osteomyelitis and soft tissue infection cases.
Main Results:
- Pseudomonas aeruginosa was identified in 10% of DFIs (104/1018 cases).
- Initial clinical failure rates were higher in pseudomonal DFIs (35%) compared to nonpseudomonal DFIs (24%, P=.02).
- Multivariate analysis revealed no significant difference in recurrence rates between pseudomonal and nonpseudomonal DFIs (HR=1.0).
Conclusions:
- Pseudomonal DFIs do not require a different therapeutic regimen than nonpseudomonal DFIs, beyond selecting an active antibiotic.
- Treatment duration or specific antibiotic combinations did not significantly impact outcomes for pseudomonal DFIs.
- Focusing on organism-specific antibiotic activity is key for managing pseudomonal DFIs effectively.
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