Perim Michele Cezimbra, Borges Joelma da Costa, Celeste Stela Regina Costa, Orsolin Ederson de Freitas, Mendes Rafael Rocha, Mendes Gabriella Oliveira, Ferreira Roumayne Lopes, Carreiro Solange Cristina, Pranchevicius Maria Cristina da Silva
Universidade Federal do Tocantins, Palmas, Tocantins, Brazil.
Setor de Cirurgia Vascular, Hospital Geral de Palmas, Palmas, Tocantins, Brazil.
Rev Soc Bras Med Trop. 2015 Sep-Oct;48(5):546-54. doi: 10.1590/0037-8682-0146-2015.
This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics.
This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)].
The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria.
The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.
本研究旨在确定从糖尿病足感染中培养出的细菌分离株的频率，并评估它们对常用抗生素的耐药性和敏感性。
这项前瞻性研究纳入了41例糖尿病足病变患者。从足部病变中分离出细菌，并使用 Kirby-Bauer 纸片扩散法和/或肉汤法[最低抑菌浓度（MIC）]确定其抗生素敏感性模式。
溃疡最常见的部位是脚趾（54%），其次是足底（27%）和背部（19%）。从30例患者中总共获得了89株细菌分离株。感染主要由革兰氏阳性菌和多微生物菌血症引起。最常分离出的革兰氏阳性菌是金黄色葡萄球菌，其次是腐生葡萄球菌、表皮葡萄球菌、无乳链球菌和肺炎链球菌。最常分离出的革兰氏阴性菌是变形杆菌属和肠杆菌属，其次是大肠杆菌、假单胞菌属和柠檬酸杆菌属。9例耐甲氧西林金黄色葡萄球菌（MRSA）对头孢西丁耐药，在这些MRSA分离株中，有3株通过MIC技术对万古霉素耐药。抗生素亚胺培南对革兰氏阳性菌和革兰氏阴性菌均最有效，庆大霉素对革兰氏阴性菌有效。
本研究证实了糖尿病足溃疡中多重耐药病原体的高流行率。有必要评估感染伤口的不同微生物，并了解感染伤口分离株的抗生素敏感性模式。这些知识对于规划使用适当抗生素进行治疗、减少耐药模式以及将医疗成本降至最低至关重要。
