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Diabetic foot infections. Bacteriologic analysis.

L J Wheat, S D Allen, M Henry

    Archives of Internal Medicine
    |October 1, 1986
    PubMed
    Summary
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    Diabetic foot infections often involve mixed bacteria. While reliable cultures are best, even unreliable ones can guide antibiotic choice for effective treatment of diabetic foot ulcers.

    Area of Science:

    • Microbiology
    • Infectious Diseases
    • Diabetology

    Background:

    • Diabetic foot infections are polymicrobial, involving aerobic and anaerobic bacteria.
    • Accurate identification of causative pathogens is crucial for effective treatment.

    Purpose of the Study:

    • To characterize the microbial flora in diabetic foot infections.
    • To evaluate the reliability of different specimen sources for culture.
    • To guide empirical antibiotic selection for diabetic foot infections.

    Main Methods:

    • Prospective evaluation of diabetic patients with foot infections over two years.
    • Collection and culture of reliable specimens (avoiding ulcer contamination) and unreliable specimens (ulcer exudate/sinus).
    • Comparison of microbial isolates from different specimen types and assessment of antibiotic coverage.

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    Main Results:

    • Common isolates include Staphylococcus, Enterococcus, Corynebacterium, Enterobacteriaceae, and anaerobic bacteria (Peptostreptococcus, Bacteroides).
    • Results from reliable and unreliable specimens showed similar common pathogens.
    • Antibiotics chosen based on unreliable specimens adequately covered pathogens from reliable cultures in 93% of cases.

    Conclusions:

    • Diabetic foot infections typically present with mixed aerobic and anaerobic bacterial flora.
    • While direct tissue cultures are preferred, ulcer exudate or sinus cultures can provide useful data for antibiotic selection.
    • Broad-spectrum antibiotics targeting both aerobic and anaerobic organisms are recommended for empirical therapy in diabetic foot infections.