Álvaro-Afonso Francisco Javier, García-Álvarez Yolanda, Tardáguila-García Aroa, García-Madrid Marta, López-Moral Mateo, Lázaro-Martínez José Luis
Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Antibiotics (Basel). 2023 Jan 19;12(2):212. doi: 10.3390/antibiotics12020212.
This study analysed the bacterial diversity, antibiotic susceptibility, and resistance in patients with complications of diabetic foot osteomyelitis (DFO). A retrospective observational study was carried out between September 2019 and September 2022 and involved 215 outpatients with a diagnosis of DFO at a specialized diabetic foot unit. A total of 204 positive bone cultures were isolated, including 62.7% monomicrobial cultures, and 37.3% were formed with at least two microorganisms. We observed that spp., Coagulase-negative staphylococci (CoNS), , , , and were the most frequently isolated microorganisms and accounted for more than 10% of the DFO cases. With stratification by Gram-positive (GP) and Gram-negative (GN) bacteria, we observed that 91.6% of cultures presented at least one GP bacteria species, and 50.4% presented at least one GN bacteria species. The most common GP species were CoNS (29%), (25.8%), and spp. (14%). The most frequent GN species consisted of spp. (32%), (23.3%), and (17.5%). The main antibiotics with resistance to GP-dominated infections were penicillins without β-lactamase inhibitor, and those in GN-dominated infections were sulfonamides and penicillins without β-lactamase. Significant differences were not observed in mean healing time in DFU with acute osteomyelitis (12.76 weeks (4.50;18)) compared to chronic osteomyelitis (15.31 weeks (7;18.25); = 0.101) and when comparing cases with soft tissue infection (15.95 (6;20)) and those without such an infection (16.59 (7.25;19.75), = 0.618). This study shows that when treatment of DFO is based on early surgical treatment, the type of DFO and the presence of soft infection are not associated with different or worse prognoses.
本研究分析了糖尿病足骨髓炎（DFO）并发症患者的细菌多样性、抗生素敏感性及耐药性。于2019年9月至2022年9月开展了一项回顾性观察研究，纳入了某专业糖尿病足诊疗单元中215例诊断为DFO的门诊患者。共分离出204份阳性骨培养物，其中62.7%为单一微生物培养物，37.3%由至少两种微生物组成。我们观察到，[具体菌种1]、凝固酶阴性葡萄球菌（CoNS）、[具体菌种2]、[具体菌种3]、[具体菌种4]和[具体菌种5]是最常分离出的微生物，占DFO病例的10%以上。按革兰氏阳性（GP）菌和革兰氏阴性（GN）菌分层后，我们观察到91.6%的培养物至少呈现一种GP菌，50.4%的培养物至少呈现一种GN菌。最常见的GP菌是CoNS（29%）、[具体菌种6]（25.8%）和[具体菌种7]（14%）。最常见的GN菌包括[具体菌种8]（32%）、[具体菌种9]（23.3%）和[具体菌种10]（17.5%）。对以GP菌为主的感染具有耐药性的主要抗生素是不含β-内酰胺酶抑制剂的青霉素，而对以GN菌为主感染具有耐药性的是磺胺类药物和不含β-内酰胺酶的青霉素。与慢性骨髓炎（15.31周（7；18.25））相比，急性骨髓炎的糖尿病足溃疡（DFU）平均愈合时间（12.76周（4.50；18））未观察到显著差异（P = 0.101）；比较有软组织感染的病例（15.95（6；20））和无此类感染的病例（16.59（7.25；19.75））时也未观察到显著差异（P = 0.618）。本研究表明，当基于早期手术治疗DFO时，DFO的类型和软组织感染的存在与不同或更差的预后无关。
