ABSTRACT
AIM: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS: The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS: A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS: Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Diabetic Foot/microbiology , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Wound Infection/drug therapy , Wound Infection/microbiology , Aged , Diabetic Foot/physiopathology , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Escherichia coli Infections/physiopathology , Female , Follow-Up Studies , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Humans , Male , Middle Aged , Practice Guidelines as Topic , Prospective Studies , Severity of Illness Index , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/physiopathology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Turkey , Wound Infection/physiopathologyABSTRACT
INTRODUCTION: After nonoperative decompression of acute sigmoid volvulus, definitive surgery is necessary because of the high risk of recurrence. However, the optimal surgical technique for this purpose has not been determined. METHODS: We studied 106 consecutive patients (mean age, 60.9 (range, 26-93) years) who underwent emergency resection for acute sigmoid volvulus between 1992 and 2000. No patient underwent preoperative decompression techniques, had the bowel prepared, or received on-table lavage. RESULTS: Depending on the patient's condition and the surgeon's preference, either primary anastomosis (57 cases) or Hartmann's procedure (49 cases) was performed. The overall mortality rate was 6.6 percent (7/106). The presence of a gangrenous bowel increased the mortality rate to 11 percent. Wound infections were documented in 8 and 12 cases, intra-abdominal abscess occurred in 1 and 7 cases, and subsequent surgery was required in 6 and 5 patients who underwent primary anastomosis and Hartmann's procedure, respectively. There were four cases of anastomotic dehiscence (7 percent) and two cases of stoma revisions (4 percent). The median length of stay was eight days for both those who underwent primary anastomosis (range, 3-27 days) and those who underwent Hartmann's procedure (range, 5-29 days). CONCLUSION: Emergent primary resection of the acute sigmoid volvulus with or without anastomosis is adequate treatment for this emergent surgical problem.
