Vinodkumar C S, Srinivasa H, Basavarajappa K G, Geethalakshmi S, Bandekar Nitin
Department of Microbiology and Surgery, S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka, India.
Indian J Pathol Microbiol. 2011 Jan-Mar;54(1):90-5. doi: 10.4103/0377-4929.77333.
While foot infections in persons with diabetes are initially treated empirically, therapy directed at known causative organisms may improve the outcome. Many studies have reported on the bacteriology of diabetic foot infections (DFIs), but the results have varied and have often been contradictory. The purpose of the research work is to call attention to a frightening twist in the antibiotic-resistant Enterococci problem in diabetic foot that has not received adequate attention from the medical fraternity and also the pharmaceutical pipeline for new antibiotics is drying up.
Adult diabetic patients admitted for lower extremity infections from July 2008 to December 2009 in the medical wards and intensive care unit of medical teaching hospitals were included in the study. The extent of the lower extremity infection on admission was assessed based on Wagner's classification from grades I to V. Specimens were collected from the lesions upon admission prior to the initiation of antibiotic therapy or within the first 48 h of admission.
During the 18-month prospective study, 32 strains of Enterococcus spp. (26 Enterococcus faecalis and 06 E. faecium) were recovered. Antibiotic sensitivity testing was done by Kirby-Bauer's disk diffusion method. Isolates were screened for high-level aminoglycoside resistance (HLAR). A total of 65.6% of Enterococcus species showed HLAR. Multidrug resistance and concomitant resistance of HLAR strains to other antibiotics were quite high. None of the Enterococcus species was resistant to vancomycin.
Multidrug-resistant Enterococci are a real problem and continuous surveillance is necessary. Today, resistance has rendered most of the original antibiotics obsolete for many infections, mandating the development of alternative anti-infection modalities. One of such alternatives stemming up from an old idea is the bacteriophage therapy. In the present study, we could able to demonstrate the viable phages against MDR E. faecalis.
虽然糖尿病患者的足部感染最初是经验性治疗，但针对已知病原体的治疗可能会改善治疗效果。许多研究报道了糖尿病足感染（DFIs）的细菌学情况，但结果各不相同，且常常相互矛盾。这项研究工作的目的是引起人们对糖尿病足中耐抗生素肠球菌问题中一个可怕转折的关注，该问题尚未得到医学界的充分重视，而且新抗生素的研发渠道也在枯竭。
纳入2008年7月至2009年12月在医学教学医院的内科病房和重症监护病房因下肢感染入院的成年糖尿病患者。入院时根据瓦格纳分级（从I级到V级）评估下肢感染的程度。在开始抗生素治疗前或入院后的头48小时内，从病变部位采集标本。
在为期18个月的前瞻性研究中，共分离出32株肠球菌（26株粪肠球菌和6株屎肠球菌）。采用 Kirby-Bauer 纸片扩散法进行药敏试验。对分离株进行高水平氨基糖苷类耐药（HLAR）筛查。共有65.6%的肠球菌表现出HLAR。HLAR菌株对其他抗生素的多重耐药和伴随耐药相当高。所有肠球菌均对万古霉素敏感。
多重耐药肠球菌是一个实际问题，需要持续监测。如今，耐药性已使大多数原有的抗生素对许多感染失效，这就需要开发替代的抗感染方式。从一个旧想法衍生出的此类替代方法之一是噬菌体疗法。在本研究中，我们能够证明针对多重耐药粪肠球菌的活噬菌体。
