Giannitsioti Efthymia, Koutserimpas Christos, Samonis George, Papadopoulos Antonios
Osseous Infectious Diseases Department, "Attikon" General University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece, PC: 124 62.
Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece, PC:11525.
Maedica (Bucur). 2023 Mar;18(1):19-26. doi: 10.26574/maedica.2023.18.1.19.
There are scarce data regarding foot osteomyelitis (FO) caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB). This study investigates the causative organisms, the diagnostic and therapeutic approach and the outcome of these infections. All patients with FO caused by MDR and/or XDR GNB who received treatment in the Department of osseous infectious diseases of the "Attikon" University Hospital of Athens, Greece, were recorded and evaluated during a six-year-period. Seventeen patients, of which 64.7% females, with a mean age of 54.06 years were studied. There were nine cases with diabetic (DFO), and 76.5% of patients reported previous use of antimicrobials. Pathogens were isolated from soft-tissue biopsies or intra-operative tissue samples (n=12) and/or affected bone samples (n=5). In most cases, and were isolated (each 29.4%), followed by (11.7%), while polymicrobial infection was detected in nine patients (53%). Most cases were given antimicrobial monotherapy (88.2%) with a mean duration of 90.05 days, while surgery significantly promoted cure of the infection. Foot and DFO cases represent a challenging to treat disease, requiring a multidisciplinary approach. Surgical treatment remains the cornerstone of treatment, while it is of utmost importance to isolate the causative organisms. MDR and XDR GNB represent an emerging threat and more data are needed to better understand these infections.
关于耐多药（MDR）和广泛耐药（XDR）革兰氏阴性菌（GNB）引起的足部骨髓炎（FO）的数据很少。本研究调查了这些感染的病原体、诊断和治疗方法以及治疗结果。对在希腊雅典“阿提卡”大学医院骨感染科接受治疗的所有由MDR和/或XDR GNB引起的FO患者进行了为期六年的记录和评估。研究了17例患者，其中64.7%为女性，平均年龄为54.06岁。有9例糖尿病足部骨髓炎（DFO）患者，76.5%的患者报告曾使用过抗菌药物。病原体从软组织活检或术中组织样本（n = 12）和/或受影响的骨样本（n = 5）中分离出来。在大多数情况下，分离出大肠埃希菌和肺炎克雷伯菌（各占29.4%），其次是鲍曼不动杆菌（11.7%），而9例患者（53%）检测到混合感染。大多数病例接受了抗菌药物单药治疗（88.2%），平均疗程为90.05天，而手术显著促进了感染的治愈。足部和DFO病例是具有挑战性的难治性疾病，需要多学科方法。手术治疗仍然是治疗的基石，同时分离出病原体至关重要。MDR和XDR GNB是一种新出现的威胁，需要更多数据来更好地了解这些感染。
