Pathogens Isolated From Deep Soft Tissue and Bone in Patients With Diabetic Foot Infections

2008 ◽  
Vol 98 (4) ◽  
pp. 290-295 ◽  
Author(s):  
M. Bulent Ertugrul ◽  
Selcuk Baktiroglu ◽  
Serpil Salman ◽  
Seher Unal ◽  
Murat Aksoy ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Culture ◽  
Tissue Cultures ◽  
Deep Soft Tissue ◽  
Diabetic Foot Infections ◽  
Grade 3 ◽  
Aseptic Conditions ◽  
Tissue Specimens ◽  
Culture Positive

Background: We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. It is widely believed that soft-tissue cultures are adequate in the determination of causative bacteria in patients with diabetic foot osteomyelitis. The culture results of specimens taken concurrently from soft-tissue and bone infections show that the former does not predict the latter with sufficient reliability. We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. Methods: Forty-five patients with diabetic foot infections were enrolled in the study. Patients had to have clinically suspected foot lesions of grade 3 or higher on the Wagner classification system. In patients with clinically suspected osteomyelitis, magnetic resonance imaging, scintigraphy, or histopathologic examination were performed. Bone and deep soft tissue specimens were obtained from all patients by open surgical procedures under aseptic conditions during debridement or amputation. The specimens were compared only with the other specimens taken from the same patients. Results: The results of bone and soft-tissue cultures were identical in 49% (n = 22) of cases. In 11% (n = 5) of cases there were no common pathogens. In 29% (n = 13) of cases there were more pathogens in the soft-tissue specimens; these microorganisms included microbes isolated from bone cultures. In four patients (9%) with culture-positive soft-tissue specimens, bone culture specimens remained sterile. In one patient (2%) with culture-positive bone specimen, soft-tissue specimen remained sterile. Conclusion: Culture specimens should be obtained from both the bone and the overlying deep soft tissue in patients with suspected osteomyelitis whose clinical conditions are suitable. The decision to administer antibiotic therapy should depend on these results. (J Am Podiatr Med Assoc 98(4): 290–295, 2008)

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

scholarly journals Association Between Diabetic Foot Infection Wound Culture Positivity and 1-Year Admission for Invasive Infection: A Multi-Center Cohort Study

2021 ◽  
Author(s):  
Westyn Branch-Elliman ◽  
Daniel Sturgeon ◽  
Adolf W Karchmer ◽  
Hillary J Mull
Keyword(s):  
Diabetic Foot ◽  
Systemic Infection ◽  
Causative Organism ◽  
Invasive Infection ◽  
Diabetic Foot Ulcers ◽  
Diabetic Foot Infections ◽  
Culture Positivity ◽  
Wound Culture ◽  
Culture Positive ◽  
Culture Negative

Abstract Inpatients with culture-positive diabetic foot infections are at elevated risk for subsequent invasive infection with the same causative organism. In outpatients with index diabetic foot ulcers, we found that wound culture positivity was independently associated with increased odds of 1-year admission for systemic infection when compared to culture-negative wounds.

Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece

2017 ◽  
Vol 16 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Maria Demetriou ◽  
Nikolaos Papanas ◽  
Periklis Panagopoulos ◽  
Maria Panopoulou ◽  
Efstratios Maltezos
Keyword(s):  
Antibiotic Resistance ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Initial Choice ◽  
Gram Positive Cocci

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

scholarly journals Optimization of the antibiotic management of diabetic foot infections - Protocol for two randomized controlled trials

2019 ◽  
Author(s):  
Felix WA Waibel ◽  
Martin Berli ◽  
Sabrina Catanzaro ◽  
Kati Sairanen ◽  
Madlaina Schöni ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Adverse Events ◽  
Antibiotic Therapy ◽  
Diabetic Foot ◽  
Randomized Clinical Trials ◽  
Antibiotic Use ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Systemic Antibiotic Therapy ◽  
Antibiotic Management

Abstract Background: Few studies address the appropriate duration of antibiotic therapy for diabetic foot infections (DFI); with or without amputation. We will perform two randomized clinical trials (RCT) to reduce the antibiotic use and associated adverse events in DFI. Methods: We hypothesize that shorter durations of post-debridement systemic antibiotic therapy are non-inferior (10% margin, 80% power, ɑ 5%) to existing (long) durations and we will perform two unblinded RCTs with a total of 400 DFI episodes (randomization 1:1) from 2019 to 2022. The primary outcome for both RCT is “remission of infection” after a minimal follow-up of two months. The secondary outcomes for both RCT are the incidence of adverse events and the overall treatment costs. The First RCT will allocate the total therapeutic amputations in two arms of 50 patients each: 1 vs. 3 weeks of antibiotic therapy for residual osteomyelitis (positive microbiological samples of the residual bone stump); or 1 vs. 4 days for remaining soft tissue infection. The Second RCT will randomize the conservative approach (only surgical debridement without in toto amputation) in two arms with 50 patients each: 10 vs. 20 days of antibiotic therapy for soft tissue infections; and 3 vs. 6 weeks for osteomyelitis. All participants will have professional wound debridement, adequate off-loading, angiology evaluation, and a concomitant surgical, re-educational, podiatric, internist and infectiology care. During the surgeries, we will collect tissues for BioBanking and future laboratory studies. Discussion: Both parellel RCTs will repond to frequent questions regarding the duration of antibiotic use in the both major subsets of DFIs, to assure the quality of care, and to avoid unnecessary excesses in terms of surgery and antibiotic use. Trial registration: ClinicalTrial.gov NCT04081792. Registered on 4th September 2019. Protocol version: 2 (15th July 2019)

scholarly journals Moderate to Severe Soft Tissue Diabetic Foot Infections

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Truong-Thanh Pham ◽  
Karim Gariani ◽  
Jean-Christophe Richard ◽  
Benjamin Kressmann ◽  
François R. Jornayvaz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Diabetic Foot Infections ◽  
Severe Soft Tissue

scholarly journals A Comparison of Tissue versus Swab Culturing of Infected Diabetic Foot Wounds

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ying Huang ◽  
Ying Cao ◽  
Mengchen Zou ◽  
Xiangrong Luo ◽  
Ya Jiang ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Prospective Trial ◽  
Punch Biopsy ◽  
Gram Negative Bacteria ◽  
Deep Tissue ◽  
Gram Negative ◽  
Diabetic Foot Infection ◽  
E Coli ◽  
Grade 3 ◽  
Tissue Specimens

Objective. To compare the efficacy of swabbing versus tissue biopsy for microbiological diagnosis of diabetic foot infection.Methods. This was a prospective trial. Fifty-six patients with diabetic foot infection were divided into the following 3 groups according to the PEDIS grading system: grade 2 (n=10), grade 3 (n=29), and grade 4 (n=17). Two specimens were collected from each wound for microbial culturing after debridement, including a superficial swab and a deep tissue punch biopsy specimen.Results. Swab culturing identified all of the microorganisms isolated from the corresponding deep tissue specimens in 9/10 of grade 2 wounds (90.0%), and this proportion decreased to 12/29 (41.4%) and 7/17 (41.2%) for grades 3 and 4 wounds, respectively (p=0.02). Moreover, the sensitivity for identifying Gram-negative bacteria, such asE. coliandCitrobacter, by swabbing was low (33.3%). In addition, some Gram-negative bacteria, such asSerratiaandRalstonia pickettii, were isolated from deep tissues but not from swabs.Conclusions. Swab culturing may be reliable for identification of pathogens in diabetic foot wounds classified as grade 2. However, it is advisable to culture deep tissue specimens for wounds of grade ≥3 because swab culturing is associated with a high risk of missing pathogens, especially Gram-negative bacteria.

Microbial Profile and Utility of Soft Tissue, Pus, and Bone Cultures in Diagnosing Diabetic Foot Infections

2012 ◽  
Vol 14 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Nadeem Parvez ◽  
Pinaki Dutta ◽  
Pallab Ray ◽  
Viral N. Shah ◽  
Mahesh Prakash ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Microbial Profile ◽  
Diabetic Foot Infections ◽  
Bone Cultures

scholarly journals Antibodies to Staphylococcus aureus Bone Sialoprotein-Binding Protein Indicate Infectious Osteomyelitis

2009 ◽  
Vol 16 (6) ◽  
pp. 949-952 ◽  
Author(s):  
Lena Persson ◽  
Christian Johansson ◽  
Cecilia Rydén
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Matrix Protein ◽  
Binding Protein ◽  
Bone Matrix ◽  
Clinical Problem ◽  
Bone Sialoprotein ◽  
Diabetic Foot Infections ◽  
Bone Matrix Protein

ABSTRACT Discrimination of soft tissue infection from osteomyelitis in diabetic foot infections is a common clinical problem. Staphylococcus aureus isolates from patients with osteomyelitis express bone sialoprotein-binding protein (Bbp) that binds the bone matrix protein bone sialoprotein. The serological assay with Bbp discriminated cases of osteomyelitis from soft tissue infections in patients with diabetic foot ulcers.

Pharmacokinetics and penetration of linezolid into inflamed soft tissue in diabetic foot infections

2008 ◽  
Vol 64 (11) ◽  
pp. 1093-1100 ◽  
Author(s):  
J. Majcher-Peszynska ◽  
G. Haase ◽  
M. Saß ◽  
R. Mundkowski ◽  
A. Pietsch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Diabetic Foot Infections
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