Enterococci in Diabetic Foot Infections: Prevalence, Clinical Characteristics, and Outcomes.

Area of Science:

• Infectious Diseases
• Podiatry
• Antimicrobial Stewardship

Background:

• Diabetic foot infections (DFIs) are often polymicrobial, with the specific role of enterococci unclear.
• The prevalence, pathogenicity, and impact of treating enterococcal DFIs require further investigation.

Purpose of the Study:

• To determine the prevalence and clinical significance of enterococci in DFIs.
• To evaluate the impact of targeted antienterococcal treatment on patient outcomes.

Main Methods:

• Retrospective analysis of demographic, clinical, and outcome data from 537 DFI patients (2014-2019).
• Primary outcome: composite of in-hospital death or major amputation.
• Secondary outcomes: any amputation, major amputation, length of stay, and 1-year mortality/major amputation rate.

Main Results:

• Enterococci were isolated in 35% of DFI cases, associated with higher peripheral vascular disease, C-reactive protein, and Wagner scores.
• Enterococci-infected patients had higher amputation rates (72.3% vs 50.1%) and longer hospital stays (22.5 vs 17 days).
• Appropriate antienterococcal antibiotics showed a trend toward reduced major amputations (20.4% vs 34.1%) but longer hospitalization.

Conclusions:

• Enterococci are prevalent in DFIs and linked to increased amputation rates and hospitalization duration.
• Retrospective data suggest appropriate antienterococcal treatment may decrease major amputation rates.
• Prospective studies are needed to validate these findings regarding enterococcal DFI treatment.