ABSTRACT
ABSTRACT Objective: The diabetic foot is a frequent complication of diabetes mellitus. It confers a negative impact on the patients' quality of life and profound burden on the healthcare system. The objectives of this study were to determine the bacteriological profile and antibiotic susceptibility of patients admitted to the University Hospital of the West Indies with diabetic foot ulcer over a 5-year period, and whether methicillin-resistant Staphylococcus aureus is a common microbial isolate and if antibiotic resistance played a role on the patients' duration of hospital stay or amputation. Methods: A retrospective analysis was done on the patients admitted from January 2003 to December 2008 with the diagnosis of diabetes mellitus and foot complications. The eligible patients and their medical records were identified by the medical records department. Their demographic data, types of cultures done and results, antibiotic susceptibility and resistance, and treatment regimens were all recorded. Frequency and means were calculated, and statistically significant covariates used as the predictors in univariate and multivariate regression models. Results: Of the 545 cases admitted, 102 had complete data for analysis. Group D Streptococci was the most common organism isolated (45.1%) followed by other forms of Streptococci and Pseudomonas aeruginosa. The majority of cases (80.6%) had two or more bacterial isolates. Gram-negative bacteria (Proteus and Klebsiella) and anaerobes were also common, 48.0% and 22.5% respectively. There were no cases of methicillin-resistant Staphylococcus aureus. Antibiotic resistance was not significant. Conclusion: Gram-positive organisms, especially the Streptococcus species, remain an important organism in diabetic foot infections. Current empiric antibiotic regimes used are effective in this tertiary care university hospital.
ABSTRACT
Microbiological surveillance program is currently performed at our tertiary-care teaching Hospital. The temporal trend of microbial isolates from patients admitted during the last four calendar years (2004 to 2007), has been analyzed according to the main bacterial and fungal cultured organisms. The same pathogens isolated more than once from the same patient within one month, have been considered only once. On the whole, the main pathogen group remained that of Enterobacteriaceae (6,608 isolations out of 19,666: 33.6%, with Escherichia coli retrieved in 60-75% of cases), with no significant difference over time. Staphylococci (4,150 isolates), and enterococci (3,276 isolates), were the two largest groups after Enterobacteriaceae, but staphylococci significantly declined during the examined four-year period (p<.001), mainly due to a progressively reduced isolation of coagulase-negative staphylococci. On the other hand, a slight increase of enterococci occurred (p<.05). Based on the frequency of isolation, Gram-negative oxydasepositive organisms accounted for 2,109 episodes, followed by other aerobe Gram-positive organisms other than Staphylococci-Enterococci (613 isolates), and anaerobes (583 isolates): no significant temporal variations occurred over time for these last microbial groups. With regard to Gram-negative oxydase-negative microorganisms (567 isolates), non-betahemolytic streptococci (464 cases), and beta-hemolytic streptococci (260 isolates), a significant trend towards a reduction of frequency occurred from the year 2004 to 2007 (p<.05 to p<.001)