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[Infections in diabetic foot. Choice of empirical antibiotic regimen].
Medicina (B Aires) 2019; 79(3):167-173M

Abstract

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Authors+Show Affiliations

Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina. E-mail: gabivcarro@yahoo.com.ar.Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Sección Microbiología, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Cirugía Vascular, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Servicio de Fisiatría, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Servicio de Clínica Médica, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.Servicio de Traumatología, Unidad de Pie Diabético, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Buenos Aires, Argentina.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

spa

PubMed ID

31284250

Citation

Carro, Gabriela V., et al. "[Infections in Diabetic Foot. Choice of Empirical Antibiotic Regimen]." Medicina, vol. 79, no. 3, 2019, pp. 167-173.
Carro GV, Carlucci E, Priore G, et al. [Infections in diabetic foot. Choice of empirical antibiotic regimen]. Medicina (B Aires). 2019;79(3):167-173.
Carro, G. V., Carlucci, E., Priore, G., Gette, F., Llanos, M. L. A., Dicatarina Losada, M. V., ... Amato, P. S. (2019). [Infections in diabetic foot. Choice of empirical antibiotic regimen]. Medicina, 79(3), pp. 167-173.
Carro GV, et al. [Infections in Diabetic Foot. Choice of Empirical Antibiotic Regimen]. Medicina (B Aires). 2019;79(3):167-173. PubMed PMID: 31284250.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Infections in diabetic foot. Choice of empirical antibiotic regimen]. AU - Carro,Gabriela V, AU - Carlucci,Elsa, AU - Priore,Graciela, AU - Gette,Fernando, AU - Llanos,María de Los Angeles, AU - Dicatarina Losada,María Victoria, AU - Noli,María Laura, AU - Amato,Pablo S, PY - 2019/7/9/entrez PY - 2019/7/10/pubmed PY - 2019/7/10/medline KW - antibiotic KW - diabetic foot infection KW - empiric regimen KW - microbiology SP - 167 EP - 173 JF - Medicina JO - Medicina (B Aires) VL - 79 IS - 3 N2 - Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections. SN - 1669-9106 UR - https://www.unboundmedicine.com/medline/citation/31284250/[Infections_in_diabetic_foot._Choice_of_empirical_antibiotic_regimen] L2 - http://www.medicinabuenosaires.com/PMID/31284250.pdf DB - PRIME DP - Unbound Medicine ER -