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[Gentamicin skin ointment: 200 kilos too much]
N H Renders1, J A Kluytmans, E Stolz
1Afd. Bacteriologie, Academisch Ziekenhuis Rotterdam-Dijkzigt.
Nederlands Tijdschrift Voor Geneeskunde
|November 11, 1995
Summary
Topical gentamicin use for diabetic foot infections can lead to antibiotic resistance. A case study found resistant Staphylococcus aureus alongside a non-resistant strain in the same patient, highlighting risks of inappropriate antibiotic application.
Area of Science:
- Medical Microbiology
- Pharmacology
- Infectious Diseases
Background:
- Diabetic mellitus type II is a common comorbidity associated with foot infections.
- Aminoglycosides, such as gentamicin, are potent antibiotics with specific indications for use.
- Topical antibiotic application requires careful consideration to prevent adverse effects like resistance.
Observation:
- A 75-year-old female patient with diabetic mellitus type II presented with a foot infection.
- Bacteriological examination identified Staphylococcus aureus resistant to aminoglycosides from one ulcer.
- A genotypically identical, but non-resistant, Staphylococcus aureus strain was isolated from another ulcer on the same foot.
Findings:
- The patient had been treated with topical gentamicin ointment, an unindicated treatment.
- The presence of both resistant and non-resistant strains suggests the development of resistance under topical gentamicin pressure.
- Literature and Dutch pharmaceutical guidelines do not support the topical use of gentamicin for such conditions.
Implications:
- Inappropriate topical aminoglycoside use can drive the selection and proliferation of antibiotic-resistant bacteria.
- Healthcare providers and regulatory bodies must reinforce guidelines against unindicated topical antibiotic use.
- This case underscores the critical need for judicious antibiotic stewardship to combat antimicrobial resistance, particularly in vulnerable patient populations.