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Microbiological Characterization of Neuropathic Diabetic Foot Infection: a Retrospective Study at a Portuguese Tertiary Hospital
Open accessPreprint — published as 10.1186/s12879-024-09677-3
Abstract
Diabetic foot infection imposes a significant burden and is the major cause of nontraumatic limb amputation. Adequate patient management with effective antibiotic therapy is crucial. This retrospective cohort study aimed to characterize the microbiology and resistance patterns of moderate to severe neuropathic diabetic foot infection in patients hospitalized at a tertiary referral hospital between January 2020 and June 2023. Deep tissue specimens from ulcers were collected for culture. Sixty inpatients were included (62% male, mean age 59.1 ± 11.5 years). Osteomyelitis was present in 90% of the patients. Among 102 microorganisms (average of 1.91 ± 1.25 pathogens per patient), 60.8% were gram-positive bacteria, 31.4% were gram-negative, 3.92% were anaerobic bacteria, and 3.92% were fungi. Staphylococcus aureus (19%) and Enterococcus faecium (17%) were the most common. Pseudomonas aeruginosa (8%) and bacteria of the Enterobacterales family (24%) accounted for all the isolated gram-negative bacteria. Sixteen percent of Staphylococcus aureus and 67% of coagulase-negative Staphylococci were resistant to methicillin. Resistance to ampicillin was found in 11% of Enterococci. All Pseudomonas aeruginosa isolates were sensitive to piperacillin-tazobactam, ceftazidime, or cefepime. Among the Enterobacterales, resistance rates were 35% for piperacillin-tazobactam, 35% for ceftazidime, 17% for cefepime, and 13% for carbapenems. Although the prevalence of methicillin-resistant staphylococci was lower than that in other studies, carbapenem resistance among gram-negative bacteria warrants attention. This study highlights the importance of understanding local epidemiology for effective diabetic foot infection management and resistance mitigation.
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10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Das, S. R., Hilliard, M. E., Isaacs, D., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s010 · Cited by 465
Research works printed but not linked: 34
- Sun H, et al. Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. · DOI · Paper page
- Ibrahim A. IDF Clinical Practice Recommendation on the Diabetic Foot: A guide for healthcare professionals. Diabetes Res Clin Pract. 2017;127:285–7. · DOI
- Mponponsuo K, Sibbald RG, Somayaji R. A Comprehensive Review of the Pathogenesis, Diagnosis, and Management of Diabetic Foot Infections. Adv Skin Wound Care. 2021;34(11):574–81. · DOI
- Schaper NC, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3266. · DOI
- Mendes JJ, et al. Clinical and bacteriological survey of diabetic foot infections in Lisbon. Diabetes Res Clin Pract. 2012;95(1):153–61. · DOI
- ElSayed NA, et al. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S203–15. · DOI · Paper page
- ElSayed NA, et al. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S191–202. · DOI
- Chuan F, et al. Reliability and validity of the perfusion, extent, depth, infection and sensation (PEDIS) classification system and score in patients with diabetic foot ulcer. PLoS ONE. 2015;10(4):e0124739. · DOI
- Alavi A, Niakosari F, Sibbald RG. When and how to perform a biopsy on a chronic wound. Adv Skin Wound Care, 2010. 23(3): p. 132 – 40; quiz 141-2. · DOI
- Senneville E, et al. Surgical techniques for Bone Biopsy in Diabetic Foot Infection, and association between results and treatment duration. J Bone Jt Infect. 2020;5(4):198–204. · DOI
- Birmpili P, et al. Outcomes after minor lower limb amputation for peripheral arterial disease and diabetes: population-based cohort study. Br J Surg. 2023;110(8):958–65. · DOI
- Hall BG, Barlow M. Revised Ambler classification of {beta}-lactamases. J Antimicrob Chemother. 2005;55(6):1050–1. · DOI
- Machado C, et al. Evolutionary trends in bacteria isolated from moderate and severe diabetic foot infections in a Portuguese tertiary center. Diabetes Metab Syndr. 2020;14(3):205–9. · DOI
- Arias M, Hassan-Reshat S, Newsholme W. Retrospective analysis of diabetic foot osteomyelitis management and outcome at a tertiary care hospital in the UK. PLoS ONE. 2019;14(5):e0216701. · DOI
- Palomo AT et al. Microbiology of Diabetic Foot Infections in a Tertiary Care Hospital in São Paulo, Brazil. Antibiot (Basel), 2022. 11(8).
- Aragón-Sánchez J, Lipsky BA, Lázaro-Martínez JL. Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation. Int J Low Extrem Wounds. 2013;12(1):63–8. · DOI
- Nathan DM, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86. · DOI · Paper page
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 1998. 352(9131): pp. 837 – 53. · DOI · Paper page
- Hawkins BK, et al. Diabetic foot infections: A microbiologic review. Foot (Edinb). 2022;51:101877. · DOI
- Lipsky BA. Bone of contention: diagnosing diabetic foot osteomyelitis. Clin Infect Dis. 2008;47(4):528–30. · DOI
- Richard JL, et al. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab. 2011;37(3):208–15. · DOI
- Veve MP, et al. Prevalence and Predictors of Pseudomonas aeruginosa Among Hospitalized Patients With Diabetic Foot Infections. Open Forum Infect Dis. 2022;9(7):ofac297. · DOI
- Dorr S, et al. Bacterial diversity and inflammatory response at first-time visit in younger and older individuals with diabetic foot infection (DFI). Acta Diabetol. 2021;58(2):181–9. · DOI
- Nelson A, et al. CODIFI (Concordance in Diabetic Foot Ulcer Infection): a cross-sectional study of wound swab versus tissue sampling in infected diabetic foot ulcers in England. BMJ Open. 2018;8(1):e019437. · DOI
- Schmidt BM, et al. Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections. Foot Ankle Spec. 2019;12(2):131–7. · DOI
- Boschetti G et al. Antimicrobial Resistance Patterns in Diabetic Foot Infections, an Epidemiological Study in Northeastern Italy. Antibiot (Basel), 2021. 10(10).
- Kim JJ, et al. Diabetic Foot Infections: Local Prevalence of and Case-Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa. Open Forum Infect Dis. 2020;7(10):ofaa412. · DOI
- Perzon O, et al. Enterococci in Diabetic Foot Infections: Prevalence, Clinical Characteristics, and Outcomes. Open Forum Infect Dis. 2023;10(5):ofad238. · DOI
- Semedo-Lemsaddek T, et al. Characterization of multidrug-resistant diabetic foot ulcer enterococci. Enferm Infecc Microbiol Clin. 2016;34(2):114–6. · DOI
- Demetriou M, et al. Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece. Int J Low Extrem Wounds. 2017;16(4):255–9. · DOI
- Kwon KT, Armstrong DG. Microbiology and Antimicrobial Therapy for Diabetic Foot Infections. Infect Chemother. 2018;50(1):11–20. · DOI
- Uivaraseanu B et al. Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome. Med (Kaunas), 2020. 56(8).
- Datta P, et al. Evaluation of various risk factors associated with multidrug-resistant organisms isolated from diabetic foot ulcer patients. J Lab Physicians. 2019;11(1):58–62. · DOI
- Thabit AK, et al. Antibiotic penetration into bone and joints: An updated review. Int J Infect Dis. 2019;81:128–36. · DOI
Metadata
- Authors
- Gonçalves, J., Guimarães, A. R., Ferreira, H. U., Ribeiro, S., Moreno, T., Borges-Canha, M., Meira, I., Menino, J., Silva, F., Pedro, J., Silva, N., Simão, R. S., Santos, L., Queirós, J., & Diabético, C. D. G. P.
- Affiliations
- Universidade do Porto (PT)
- Unidade Local de Saúde de São João
- Hospital de São João (PT)
- Corresponding author
- Gonçalves, Juliana
- ORCID
- Venue
- BMC Infectious Diseases
- Published
- 2024-06-17
- Volume
- 24
- Issue
- 1
- Pages
- 791-791
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC11305078
- OpenAlex
- W4401364970
- Cited by
- 11
- References
- 1
- Citations by year
- 2026: 7 · 2025: 4
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by-nc-nd)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Universidade do Porto
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Keywords
- diabetic foot infection, neuropathic diabetic foot, osteomyelitis, antimicrobial resistance, methicillin-resistant Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, Enterobacterales, carbapenem resistance, Gram-negative bacteria, Staphylococcus aureus, coagulase-negative staphylococci, ampicillin resistance, piperacillin-tazobactam resistance, deep tissue culture, fungal infection
- MeSH terms
- Aged, Anti-Bacterial Agents, Bacteria, Female, Gram-Negative Bacteria, Gram-Positive Bacteria, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Osteomyelitis, Portugal, Retrospective Studies, Diabetic Foot, Tertiary Care Centers
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