Department of Angiology, Systemic Hypertension and Diabetology, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2014 Jan-Feb;23(1):39-48. doi: 10.17219/acem/37020.
Diabetic foot syndrome (DFS) represents one of the most frequent reasons for lower limb amputation in developed countries. In most cases, it is associated with bacterial infection, requiring optimal antibiotic therapy.
The aim of this study was to identify the most frequent pathogens responsible for infections associated with DFS, establish the optimal protocol of empirical therapy, and ascertain the clinical variables that may determine the choice of the appropriate antibacterial agent.
The analysis included hospital records of patients treated at the Department between 2008 and 2010. A total of 102 individuals were identified; their material was cultured and tested for antibiotic susceptibility.
A total of 199 bacterial strains were isolated. There was a predominance of Gram-positive bacteria, particularly Staphylococcus aureus, Staphylococcus coagulase-negative strains, and Enterococcus faecalis. Of note was the high percentage of E. faecalis infection (16.08%). One can speculate on the potential etiological factors in the case of some bacteria, e.g. patients infected with S. aureus were characterized by higher monocytosis and lymphocytosis as compared to other patients. Analysis of drug susceptibility revealed that ciprofloxacin has the highest (but still only 44%) efficacy of all agents tested as monotherapy, and a combination of piperacillin and tazobactam or amoxicillin and clavulanate with aminoglycosides is particularly beneficial.
Staphylococcus spp. predominates amongst the etiological factors of DFS infection; however, the rate of E. faecalis infection is alarmingly high. Monotherapy enables effective treatment in a minority of cases; therefore, at least two-drug protocols should be implemented from the very beginning of the therapy.
糖尿病足综合征（DFS）是发达国家下肢截肢最常见的原因之一。在大多数情况下，它与细菌感染有关，需要进行最佳的抗生素治疗。
本研究旨在确定导致与 DFS 相关感染的最常见病原体，制定最佳经验性治疗方案，并确定可能决定选择适当抗菌药物的临床变量。
该分析包括 2008 年至 2010 年在该部门治疗的患者的住院记录。共确定了 102 名个体；对其进行了培养并进行了抗生素敏感性测试。
共分离出 199 株细菌。革兰氏阳性菌占优势，特别是金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌。值得注意的是，粪肠球菌感染率很高（16.08%）。对于某些细菌，人们可以推测潜在的病因因素，例如感染金黄色葡萄球菌的患者与其他患者相比单核细胞和淋巴细胞增多。药物敏感性分析表明，环丙沙星作为单一药物的疗效最高（但仍只有 44%），而哌拉西林和他唑巴坦或阿莫西林和克拉维酸与氨基糖苷类药物的联合使用特别有益。
葡萄球菌属是 DFS 感染的主要病因，但粪肠球菌的感染率高得令人震惊。单一疗法仅能有效治疗少数病例；因此，应从治疗开始就实施至少两药方案。
