Sekhar M Sonal, M K Unnikrishnan, Rodrigues Gabriel Sunil, Vyas Navya, Mukhopadhyay Chiranjay
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India.
Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India.
Foot (Edinb). 2018 Dec;37:95-100. doi: 10.1016/j.foot.2018.07.002. Epub 2018 Jul 11.
Diabetic foot infections (DFIs) are major public health concerns. In the view of the ever increasing burden of multidrug-resistant (MDR) organisms, improving the use of antimicrobial agents (AMAs) is a national priority. Objective of the study was to determine antimicrobial susceptibility (AMS) pattern of aerobes in DFIs.
A cross-sectional study was conducted for a period of 3 years at Department of Surgery, Kasturba hospital, Manipal, India during which, 260 diabetic foot ulcer (DFU) patients admitted in the general surgery wards were enrolled for the study. These patients' culture specimens were observed as Gram-stained smears and cultured aerobically on blood agar and MacConkey agar plates. AMS test was performed by disc diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines.
A total of 354 microbes were isolated from the ulcer wounds of 213 diabetic foot patients, with an average of 1.7 organisms per lesion. Monomicrobial infections were less common (n=81; 31.2%) than polymicrobial infections (n=132; 50.7%). Gram-negative bacteria were the most common among the isolates (n=192; 54.2%). Aerobic Gram-positive Cocci accounted for 162 (45.8%) of all isolates. On the other hand, Staphylococcus aureus was the most frequently isolated aerobe (n=106; 29.9%) followed by Pseudomonas aeruginosa (n=91; 25.7%).
AMS data from our study recommends that doxycycline would be the appropriate choice as single drug for empirical coverage for Gram-positive organisms. The most appropriate antibiotic for Gram-negative organisms is meropenem. One of the critical observations is the presence of Acinetobacter, an MDR isolated from DFIs, which is either relatively or totally resistant to all the AMAs tested.
糖尿病足感染（DFIs）是主要的公共卫生问题。鉴于多重耐药（MDR）菌的负担不断增加，改善抗菌药物（AMAs）的使用是一项国家优先事项。本研究的目的是确定DFIs中需氧菌的抗菌药敏（AMS）模式。
在印度马尼帕尔卡斯图尔巴医院外科进行了一项为期3年的横断面研究，在此期间，纳入了普通外科病房收治的260例糖尿病足溃疡（DFU）患者进行研究。观察这些患者的培养标本的革兰氏染色涂片，并在血琼脂和麦康凯琼脂平板上进行需氧培养。根据临床和实验室标准协会（CLSI）指南，采用纸片扩散法进行AMS试验。
从213例糖尿病足患者的溃疡伤口中共分离出354株微生物，每个病变平均分离出1.7株菌。单微生物感染（n=81；31.2%）不如多微生物感染（n=132；50.7%）常见。革兰氏阴性菌是分离株中最常见的（n=192；54.2%）。需氧革兰氏阳性球菌占所有分离株的162株（45.8%）。另一方面，金黄色葡萄球菌是最常分离出的需氧菌（n=106；29.9%），其次是铜绿假单胞菌（n=91；25.7%）。
我们研究的AMS数据表明，强力霉素作为覆盖革兰氏阳性菌的经验性单药治疗是合适的选择。治疗革兰氏阴性菌最合适抗生素是美罗培南。一项关键观察结果是从DFIs中分离出的多重耐药菌不动杆菌的存在，它对所有测试的AMAs相对或完全耐药。
