Reveles Kelly R, Duhon Bryson M, Moore Robert J, Hand Elizabeth O, Howell Crystal K
College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States of America.
Pharmacotherapy Education & Research Center, University of Texas Health Science Center San Antonio, San Antonio, Texas, United States of America.
PLoS One. 2016 Aug 24;11(8):e0161658. doi: 10.1371/journal.pone.0161658. eCollection 2016.
Diabetic foot infections (DFIs) are the leading cause of non-traumatic lower extremity amputations in the United States. Antimicrobials active against methicillin-resistant Staphylococcus aureus (MRSA) are recommended in patients with associated risk factors; however, limited data exist to support these recommendations. Due to the changing epidemiology of MRSA, and the consequences of unnecessary antibiotic therapy, guidance regarding the necessity of empirical MRSA coverage in DFIs is needed. We sought to 1) describe the prevalence of MRSA DFIs at our institution and compare to the proportion of patients who receive MRSA antibiotic coverage and 2) identify risk factors for MRSA DFI.
This was a retrospective cohort study of all adult, culture-positive DFI patients managed at University Hospital, San Antonio, TX between January 1, 2010 and September 1, 2014. Patient eligibility included a principal ICD-9-CM discharge diagnosis code for foot infection and a secondary diagnosis of diabetes. The primary outcome was MRSA identified in the wound culture. Independent variables assessed included patient demographics, comorbidities, prior hospitalization, DFI therapies, prior antibiotics, prior MRSA infection, and laboratory values. Multivariable logistic regression was used to identify risk factors for MRSA DFI.
Overall, 318 patients met inclusion criteria. Patients were predominantly Hispanic (79%) and male (69%). Common comorbidities included hypertension (76%), dyslipidemia (52%), and obesity (49%). S. aureus was present in 46% of culture-positive DFIs (MRSA, 15%). A total of 273 patients (86%) received MRSA antibiotic coverage, resulting in 71% unnecessary use. Male gender (OR 3.09, 95% CI 1.37-7.99) and bone involvement (OR 1.93, 1.00-3.78) were found to be independent risk factors for MRSA DFI.
Although MRSA was the causative pathogen in a small number of DFI, antibiotic coverage targeted against MRSA was unnecessarily high.
糖尿病足感染（DFIs）是美国非创伤性下肢截肢的主要原因。对于有相关风险因素的患者，推荐使用对耐甲氧西林金黄色葡萄球菌（MRSA）有效的抗菌药物；然而，支持这些推荐的数据有限。由于MRSA的流行病学变化以及不必要抗生素治疗的后果，需要有关DFIs中经验性覆盖MRSA必要性的指导。我们试图：1）描述我院MRSA DFI的患病率，并与接受MRSA抗生素覆盖的患者比例进行比较；2）确定MRSA DFI的风险因素。
这是一项对2010年1月1日至2014年9月1日在德克萨斯州圣安东尼奥市大学医院接受治疗的所有成年、培养阳性DFI患者进行的回顾性队列研究。患者入选标准包括足部感染的主要ICD-9-CM出院诊断代码和糖尿病的次要诊断。主要结局是伤口培养中鉴定出MRSA。评估的独立变量包括患者人口统计学、合并症、既往住院史、DFI治疗、既往抗生素使用、既往MRSA感染和实验室值。多变量逻辑回归用于确定MRSA DFI的风险因素。
总体而言，318例患者符合纳入标准。患者主要为西班牙裔（79%）和男性（69%）。常见合并症包括高血压（76%）、血脂异常（52%）和肥胖（49%）。在46%的培养阳性DFIs中存在金黄色葡萄球菌（MRSA占15%）。共有273例患者（86%）接受了MRSA抗生素覆盖，导致71%的不必要使用。男性（OR 3.09，95%CI 1.37-7.99）和骨受累（OR 1.93，1.00-3.78）被发现是MRSA DFI的独立风险因素。
尽管MRSA是少数DFIs中的致病病原体，但针对MRSA的抗生素覆盖不必要地高。
