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Diabetic Foot Infection
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Jaime Benarroch-Gampel, James Middleton Chang
Risk factors associated with development of foot infections include ulcers associated with trauma, exposed bone, ulcer duration longer than 30 days, recurrent ulcers, prior amputation, neuropathy, and presence of concomitant peripheral arterial disease (PAD) (Hobizal and Wukich, 2012). The diagnosis of a diabetic foot infection is based on clinical signs and symptoms ranging from local (foul-smelling purulent discharge, pain, swelling, and erythema) to systemic sepsis and even ultimately to shock. A detailed vascular examination is critical to determine the presence and severity of PAD, as this increases the risk of non-healing ulcers, recurrence, and amputations (Armstrong et al., 2017).
Ampicillin–Sulbactam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Petros I. Rafailidis, Matthew E. Falagas
A significant cause of morbidity in the diabetic patient population is diabetic foot infection (Lipsky et al., 2004). A double-blind randomized study comparing imipenem–cilastatin (I/C) (0.5 g every 6 hours) and AMP/S (3 g every 6 hours) in limb-threatening infections in diabetic patients found similar results for the two regimens. After 5 days of empiric treatment, improvement was achieved in 94% of 48 AMP/S-treated infections and in 98% of 48 I/C-treated infections. Cure rates were 81% for the AMP/S group versus 85% for the I/C group; failure rates were 17% and 13%, respectively, and bacterial eradication rates were 67% and 75%, respectively. The episodes of treatment failures were associated with pathogens with antibiotic resistance and acquisition of nosocomial pathogens (Grayson et al., 1994). A cost-effectiveness analysis of this study by Grayson et al. (1994) that was performed retrospectively (McKinnon et al., 1997) showed that the mean per patient treatment cost was 14084 US dollars in the A/S group versus 17008 US dollars in the I/C group.
Anti-pseudomonal and anti-endotoxic effects of surfactin-stabilized biogenic silver nanocubes ameliorated wound repair in streptozotocin-induced diabetic mice
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Natarajan Krishnan, Balasubramanian Velramar, Rajesh Pandiyan, Rajesh Kannan Velu
Diabetic foot infection is a frequent clinical problem in diabetic patients which needs to be understood better and addressed with utmost attention. The disease demands proper management failing which the extrication of limb becomes inevitable and amputation brings down the life span of individual as quickly as cancer. The most important aim of diabetic foot infection therapy is to make the patient avoid the limb loss and that survival of the patient is not put to any risk due to terminal infections [14]. Infections in the diabetic wound are polymicrobial in origin with predominant representation from the Gram-negative organisms in tropical Asian countries and in India, unlike the temperate western geographic regions. Pseudomonas aeruginosa the dreaded Gram-negative bacterium associated is of major concern in diabetic foot infection [15,16]. Although the infecting pathogen tends not to invade deeper tissues, it releases a variety of virulence factors, including endotoxin (LPS) causing significant wound deterioration and hence prolongs the ulcer to heal [17,18].
Management of bacterial skin and skin structure infections with polymicrobial etiology
Published in Expert Review of Anti-infective Therapy, 2019
Silvano Esposito, Tiziana Ascione, Pasquale Pagliano
Diabetic foot infection is typically a polymicrobial infection. S. aureus is the microorganism isolated with the highest frequency. In patients with mild infection who did not recently receive antimicrobial therapy aerobic Gram-positive cocci are isolated with the highest frequency. Instead, the higher is the frequency of previous antibiotic treatments and the severity of the infection, the higher is the probability to have a polymicrobial infection sustained by MDR Gram negative bacilli and by MRSA [44,45].
Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry
Published in Journal of Chemotherapy, 2022
Silvano Esposito, Pasquale Pagliano, Giuseppe De Simone, Angelo Pan, Paola Brambilla, Gianni Gattuso, Claudio Mastroianni, Blertha Kertusha, Carlo Contini, Lorenzo Massoli, Daniela Francisci, Giulia Priante, Marco Libanore, Roberto Bicocchi, Guglielmo Borgia, Alberto Enrico Maraolo, Pierluigi Brugnaro, Sandro Panese, Alessandra Calabresi, Giovanni Amendola, Francesca Savalli, Consuelo Geraci, Andrea Tedesco, Sara Fossati, Anna Carretta, Teresa Santantonio, Giovanni Cenderello, Maria Paola Crisalli, Elisabetta Schiaroli, Pierangelo Rovere, Giulia Masini, Roberto Ferretto, Antonio Cascio, Claudia Colomba, Claudia Gioè, Mario Tumbarello, Angela Raffaella Losito, Giuseppe Foti, Tullio Prestileo, Calogero Buscemi, Chiara Iaria, Carmelo Iacobello, Sofia Sonia, Giulio Starnini, Anna Ialungo, Mauro Sapienza
Diabetes mellitus and cardiovascular diseases were the most frequent comorbidities (31.1% and 38.8% of total patients suffering, respectively). It is of particular interest that patients with diabetes mellitus report a five-fold higher risk to acquire an SSTI than the general population (31.1% vs 9%). Similar findings were reported by Garau et al (33.9%) [18]. The above data strongly suggest that diabetic patients have a major susceptibility to infection, probably due to prolonged oxidative stress and cytokine dysregulation resulting in compromised arterial circulation and impaired immunologic response to pathogens [7, 22–24]. Moreover, although there is no universal agreement on how far this increased risk is directly related to poor glycaemic control, recent large-scale investigations demonstrated that not only diabetics are more likely to develop SSTIs but, among the patients admitted for SSTI, diabetics also have a five times higher risk of developing complications (e.g. impairment of skeletal causing diabetic foot osteomyelitis, or remote-site invasive infection such as endocarditis) [25, 26]. According to the International Diabetes Federation the prevalence of Diabetic Foot Infection (DFI) is approximately 9.1–26.1 cases per million people with diabetes per year and half of them develop furthermore DFI [27]. Therefore, it is hardly surprising that in our registry, diabetic foot infections (DFIs) are the most frequently occurring infections (28.2%) in diabetic patients, but it is noteworthy that also other types of infections are often reported: cellulitis (22.1%), erysipelas (10.1%), surgical site infection (8.7%) and abscess (8.7%). All these infections can progress rapidly with a potential severe morbidity; therefore, diabetic patients need particular care to early suspicion (they are often unaware that the skin infection is present at the beginning), diagnosis and to prevent any SSTIs (not only DFI) and their complications [24, 28].