Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Analysis of Initial Choice Antibiotics Efficacy in Diabetic Foot Infection

당뇨병성 족부 감염 환자의 초기 선택 항생제 효율성

  • Lee, Doo-Hyung (Department of Orthopaedic Surgery, Ajou University School of Medicine) ;
  • Han, Seung-Hwan (Department of Orthopaedic Surgery, Ajou University School of Medicine) ;
  • Park, Min-Jung (Department of Orthopaedic Surgery, Ajou University School of Medicine)
  • 이두형 (아주대학교 의과대학 정형외과학교실) ;
  • 한승환 (아주대학교 의과대학 정형외과학교실) ;
  • 박민정 (아주대학교 의과대학 정형외과학교실)
  • Published : 2009.12.15
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Abstract

Purpose: Foot infections are common complications in patients with diabetes. The patients are usually immune-compromised; therefore the pathogens could be resistant to narrow spectrum antibiotics. Those drugs, however, are categorized as specially managed antibiotics, and access are difficult without confirming of the pathogens. Our aim was to analyze the common pathogens in diabetic foot infection and figure out the proper antibiotics. Materials and Methods: We studied 68 patients treated with diabetic foot infection. The pathogens which caused the infection and their sensitivity to initial antibiotics were analyzed. We also investigated the change of the antibiotics after the confirming of the culture result and average time to get the result. Results: Among the 68 patients, 56 (82%) received cephalosporin and beta-lactam antibiotics. Only 12 (18%) who were confirmed the drug resistant pathogens from previous culture, were treated with broad spectrum antibiotics such as vancomycin and tazoperan. Average culture study time was 6 days. Methicillin-resistant staphylococcus aureus (MRSA) was cultured in 19 patients (28%), Methicillin-resistant coagulase negative staphylococcus (MRCNS) in 11 patietns (17%), pseudomonas in 11 patients (17%). Total 44 (65%) including 3 of other antibiotics resistant pathogen needed broad spectrum antibiotics. Thirty two patients (47%) were resistant to initial antibiotics.irt follow up culture, 2 MRSA and 2 MRCNS were found. The antibiotics resistant pathogens were confirmed in 48 (71%) patients at last. Conclusion: Diabetic patients with foot infection need proper antibiotics from initial treatment. The proper broad spectrum antibiotics should assigned to the patients from the first time without the confirming of the culture results.

Keywords

References

  1. Andersen CA and Roukis TS: The diabetic foot. Surg Clin N Am, 87: 1149-1177, 2007. https://doi.org/10.1016/j.suc.2007.08.001
  2. Apelqist J and larssoon J: What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev, 16 (Suppl 1): S75-83, 2000. https://doi.org/10.1002/1520-7560(200009/10)16:1+<::AID-DMRR139>3.0.CO;2-8
  3. Armstrong DG, Lavery LA, van Houtum WH and Harkless LB: Seasonal variations in lower extermity amptation. J Foot Ankle Surg, 36: 146-150, 1997. https://doi.org/10.1016/S1067-2516(97)80062-2
  4. Brodsky JW: The diabetic foot. In Coughlin MJ, Mann RA and Saltzman CL eds. Surgery of the foot and ankle. 8th ed. philadelphia, Mosby: 1181-1368, 2007.
  5. Cunha BA: Antibiotic selection for diabetic foot infections: a review. J Foot Ankle Surg, 39: 253-257, 2000. https://doi.org/10.1016/S1067-2516(00)80009-5
  6. Frykberg RG, Zgonis T, Armstrong DG, et al: Diabetic foot disorders. A clinical Practice Guideline (2006 revision). J Foot Ankle Surg, 45(5 Suppl): S1-66, 2006. https://doi.org/10.1016/S1067-2516(07)60001-5
  7. International Working Group on the Diabetic Foot: International consensus on the diabetic foot and practical guidelines on the management and prevention of the diabetic foot. 5th International Symposium on the Diabetic Foot. Noordwijkerhout, 2007.
  8. Leaper DJ: Silver dressings: their role in wound management. Int Wound J, 3: 282-294, 2006. https://doi.org/10.1111/j.1742-481X.2006.00265.x
  9. Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE and Abramson MA: Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet, 366: 1695-1703, 2005. https://doi.org/10.1016/S0140-6736(05)67694-5
  10. Lipsky BA, Berendt AR, Deery HG, et al: Diagnosis and treatment of diabetic foot infection. Clin Infect Dis, 39: 885-910, 2004. https://doi.org/10.1086/424846
  11. Most RS and Sinnock P: The epidemiology of lower extremity amputations in diabetic individuals. Diabetes Care, 6: 87-91, 1983. https://doi.org/10.2337/diacare.6.1.87
  12. Pinzur MS, Slovenkai MP, Trepman E and Shields NN: Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committe of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int, 26: 113-119, 2005.
  13. Schultz G, Sibbald RG, Falanga V, et al: Wound bed preparation: a systemic approach to wound management. Wound Repair Regen, 11Supple 1: S1-28, 2003. https://doi.org/10.1046/j.1524-475X.11.s2.1.x
  14. Senneville E: Antimicrobacial interventions for the management of diabetic foot infections. Expert Opin Pharmacother, 6: 263-273, 2005. https://doi.org/10.1517/14656566.6.2.263
  15. Williams R and Airey M: The size of the problem: epidemiological and economical aspects of foot problems in diabets. In: Boulton AJM, Conner H, Cavanagh PR, eds. The foot in diabetes. 3r ed. London, John Wiley & Sons: 3-17, 2000.