Virulence genes profile and biofilm formation of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus isolates from diabetic foot infections

Aims@#Diabetic foot infections (DFIs) represent one of the most important risk factors for lower extremity amputation. One of the major infection agents that causes DFIs is Staphylococcus aureus. Staphylococcus aureus is an important human pathogen causing variety of clinical manifestations which can lead to invasive infections, sepsis and even death. Outcomes of antibiotic treatment of diabetic foot infections may depend not only on the antimicrobial susceptibility of the etiological agents, but also their ability to produce diverse virulence factors. This study was aimed to investigate biofilm production and the presence of various virulence genes among Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-susceptible Staphylococcus aureus (MSSA) isolates obtained from patients with DFIs. @*Methodology and results@#A total of 48 clinical MRSA and MSSA isolates obtained from diabetic foot patients were studied for their biofilm formation and the presence of 29 known virulence genes. The biofilm formation was observed, analyzed and quantified using the microtiter plate method. Biofilm production was observed as 95.50% and 92.00% in the MRSA and MSSA isolates, respectively. Among the 29 virulence genes tested on the 48 clinical isolates, 19 virulence genes were detected. It was found that aap (62.50%), etd (54.17%), icaD (50.00%), aae (50.00%), seh (31.25%) and icaADB (22.92%) were the most prevalent genes. A total of 10 virulence genes (etb, gehD, icaB, icaC, seb, hla_haem, hld_epid, altE, fbe and sesI) were absent in all the isolates used.@*Conclusion, significance and impact of study@#Virulence genes play important role in clinical infections. Our results showed the presence rates of biofilm formation and accumulation-associated factors that are high among MRSA as well as MSSA isolates from DFIs. These results confirmed the importance of biofilm formation as regarded for DFIs.

Prescription Pattern And Usage Of Antimicrobial Agents For Treating Diabetic Foot Infections At Tertiary Care Centre

Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used. Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel. Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms. Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.

A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.

Infecciones en Pie Diabético. Serie de Casos / Diabetic Foot Infections. Case Series

Introducción El objetivo de este trabajo es describir las características clínicas, gérmenes aislados en muestras tomadas en quirófano, tipo de procedimientos quirúrgicos y desenlaces en el tratamiento realizado a pacientes con pie diabético atendidos en nuestra institución. Materiales y Metodos Estudio descriptivo retrospectivo observacional tipo serie de casos, describiendo resultados obtenidos de los cultivos tomados en cirugía, características clínicas según la clasificación de Wagner, número y tipo de procedimientos entre Enero de 2012 y Diciembre de 2016 por complicaciones derivadas de pie diabético. Resultados Se obtuvieron 58 pacientes, con edad media de 65 años, 69% eran varones. El estadio clínico en la evaluación prequirúrgica fue de 39.7% Wagner III, 37.9% IV; en la evaluación intraquirúrgica fue 32.8% III, 50% IV. Los gérmenes aislados, en 1er lugar 15.5% Escherichia Coli, de estas 11.9% era BLEE positiva y 3.6% multisensible; otro 15.5% Pseudomona Aeruginosa, variantes multirresistentes 10.7% productoras de carbapenemasas 1.2%, y resistentes a meropenem 1.2% y multisensibles 2.4%. 77.5% de los pacientes requirió cambio de antibiótico. Un tercio de los pacientes requirieron amputaciones mayores de los cuales 46.6% presentaban infecciones por gérmenes de multirresistentes. Discusión Encontramos que los gérmenes predominantes son bacilos gram negativos en su mayoría multirresistente. Sugerimos la toma de muestras de manera intraquirúrgica previo al inicio de antibioticoterapia. Dado la flora bacteriana aislada en esta serie, al iniciar antibioticoterapia empírica se sugiere el uso de carbapenémicos.

Background The main purpose of the study is to describe the clinical characteristics, micro-organisms isolated in specimens taken in the operating room, types of surgical procedures, and outcomes in treatments performed on patients with diabetic foot. Methods A case series study is presented, describing results obtained from cultures taken in surgery, clinical characteristics according to Wagner's classification, and number and type of procedures performed between January 2012 and December 2016 due to complications derived from diabetic foot.. Results The study included 58 patients, with a mean age of 65 years, and 69% were men. The clinical stage in the pre-surgical evaluation was 39.7% and 37.9% Wagner III and IV, respectively, and during the operation it was 32.8% III, 50% IV. The isolated micro-organisms were 15.5% Escherichia Coli, of these 11.9% were ESBL positive and 3.6% multisensitive. Another 15.5% were Pseudomonas Aeruginosa, multiresistant variants 10.7%, producing carbapenemases 1.2%, resistant to meropenem 1.2%, and multiple sensitivity 2.4%. The large majority (77.5%) of the patients required a change of antibiotic. One third of the patients required major amputations, of which 46.6% had infections caused by multidrug-resistant germs. Discussion The predominant micro-organisms found were multi-resistant gram negative bacilli. It is suggested taking specimens intraoperative prior to the start of antibiotic therapy. Given the bacterial flora isolated in this series, when starting empirical antibiotic therapy, the use of carbapenems is suggested.

Interdigital foot infections: Corynebacterium minutissimum and agents of superficial mycoses

Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly with the use of 20% potassium hydroxide mounts and Gram stain under the microscope and cultured on Sabouraud's dextrose agar plates. In identification of superficial mycoses, the rate was found to be 14% with the cultural method and 14% with direct microscopic examination. Using a combination of direct microscopic examination and culture, a 33.8% ratio was achieved. In the culture of these samples, the most isolated factor was Trichophyton rubrum (33.7%). In 24 of the patients (19.8%) Corynebacterium minutissimum was detected by Gram staining, in 6 of these patients Trichophyton rubrum was found, Trichophyton mentagrophytes was found in 2 and Trichosporon spp. was found in 1. The examination of interdigital foot lesions in the laboratory, the coexistence of erythrasma with dermatophytes and yeast should be considered.

‘Does the National Antibiotic Guideline- 2008 remain applicable for treating diabetic foot infection?’ A new evidence-based regional study on culture and sensitivity patterns in Terengganu population

Diabetic foot infections make up a significant number of orthopaedic ward admissions. The recommended choice of empirical antibiotics used in Malaysia for diabetic foot infections is based on the National Antibiotic Guidelines 2008. The pattern of bacteriology and the effectiveness of the treatment of diabetic foot infections based on this guideline were analyzed through a retrospective study in our hospital. Data over a period of one year (May 2012- April 2013) was analyzed, and 96 patients were included in this study. Polymicrobial growth (58%) was mainly isolated, followed with an almost equal percentage of gram-negative (22%) and gram-positive organisms (20%). The empirical antibiotics based on the national antibiotic guidelines were used as definitive antibiotics in 85% of the cases. Although there was slight variation in the pattern of organisms as compared to other studies conducted in this country, the high rate of positive clinical response proved that the antibiotic guideline was still effective in diabetic foot infection treatment.

Diabetic foot complications among patients attending a specialist diabetes clinic in Jamaica: prevalence and associated factors / Complicaciones del pie diabético entre pacientes que asistían a una clínica especializada de diabetes en Jamaica: prevalencia y pactores asociados

OBJECTIVES: To estimate the prevalence of diabetic foot complications among patients at a specialist diabetes clinic in Jamaica and identify factors associated with foot complications. METHODS: A stratified random sample of 188 patients were interviewed and examined between 2009 and 2010. Trained nurses obtained demographic and clinical data, measured anthropometrics and performed foot examinations including inspection for amputations, ulcers or infection and assessment of pain, vibration and pressure perception. RESULTS: Participants included 143 women and 45 men (mean age 56 years; mean diabetes duration 16 years). The prevalence of amputations was 8.5% (95% CI 4.5, 12.5%) and was higher among men (22.2%) compared to women (4.2%, p < 0.05). Prevalence of current ulcers and current foot infections was 4.3% and 3.7%, respectively. Overall, 12% of patients had at least one of these foot complications. Foot complications were more prevalent among men, patients with high blood pressure (BP > 130/80 mmHg) or peripheral neuropathy. In multivariable logistic regression models, factors associated with foot complications were: neuropathy (OR 9.3 [95% CI 2.8, 30.3]), high BP (OR 7.9 [1.3, 49.7]) and diabetes duration (OR 1.32 [1.02, 1.72]). CONCLUSION: Approximately one of every eight patients in this specialist clinic had a major foot complication. Associated factors were neuropathy, high blood pressure and longer duration of diabetes.

OBJETIVOS: Estimar la prevalencia de complicaciones de pie diabético entre pacientes de una clínica especializada en diabetes en Jamaica, e identificar los factores asociados con complicaciones de pie. SUJETOS Y MÉTODOS: Se realizaron entrevistas y exámenes a una muestra aleatoria estratificada de 188 pacientes entre 2009 y 2010. Enfermeras entrenadas obtuvieron datos demográficos y clínicos, realizaron mediciones antropométricas, así como exámenes de pie - incluyendo la inspección de las amputaciones, las úlceras o infección, y evaluación de la percepción del dolor, la vibración y la presión. RESULTADOS: Los participantes incluyeron 143 mujeres y 45 hombres (edad promedio: 56 años; duración promedio de la diabetes: 16 años). La prevalencia de las amputaciones fue 8.5% (IC de 95%: 4.5, 12.5%) y fue mayor entre los hombres (22.2%) en comparación con las mujeres (4.2%, p < 0.05). La prevalencia de las úlceras e infecciones de pie corrientes fue de 4.3% y 3.7%, respectivamente. En general, 12% de los pacientes tenían al menos una de estas complicaciones de pie. Las complicaciones de pie fueron más frecuentes entre los hombres, los pacientes con hipertensión arterial (BP > 130/80 mmHg), o con neuropatía periférica. De acuerdo con los modelos de regresión logística multivariable, los factores asociados con las complicaciones de pie fueron: la neuropatía (OR 9.3 [95% CI 2.8, 30.3]), BP alto (OR 7.9 [1.3, 49.7]) y la duración de la diabetes (OR 1.32 [1.02, 1.72]). CONCLUSIÓN: Aproximadamente uno de cada ocho pacientes en esta clínica especializada tuvo una complicación de pie importante. Los factores asociados fueron: neuropatía, presión alta y mayor duración de la diabetes.