Goldstein E J, Citron D M, Nesbit C A
R.M. Alden Research Laboratory, Santa Monica Hospital Medical Center, California 90404, USA.
Diabetes Care. 1996 Jun;19(6):638-41. doi: 10.2337/diacare.19.6.638.
To study the relative frequency of bacterial isolates cultured from community-acquired foot infections and assess their comparative in vitro susceptibility to sparfloxacin, levofloxacin, and eight other commonly used oral antimicrobial agents.
This is a prospective study in which the infected wounds of 25 consecutive diabetic patients seen by one of the authors were cultured as they entered the hospital. Isolates were stored and tested for susceptibility to 10 oral antimicrobial agents using the agar dilution method.
Staphylococcus aurcus was the most common isolate (76% of patients), including methicillin-resistant S. aurcus (MRSA) in 5 of 25 (20%) patient wounds. Streptococci, enterococci, Enterobacteriaceae, and anaerobes were also present in > or = 40% of patient wounds. Sparfloxacin and levofloxacin were the most active agents tested with activity against > or = 88% of isolates. Isolates resistant to sparfloxacin and levofloxacin included MRSA, enterococci, and some anaerobes. When analyzed by prior exposure to antibiotics, patients who had previously received oral antibiotics were more likely to have MRSA, enterococci, and Pseudomonas aeruginosa isolated and less likely to have Enterobacteriaceae and anaerobes isolated from their wounds.
MRSA and enterococci are now a common cause of diabetic foot infections, and the increased prevalence may be due to antimicrobial use. These wounds may require use of combined antimicrobial therapy for initial outpatient management. The new fluoroquinolones, sparfloxacin and levofloxacin, were the most active oral agents tested.
研究从社区获得性足部感染中培养出的细菌分离株的相对频率，并评估它们对司帕沙星、左氧氟沙星和其他8种常用口服抗菌药物的体外敏感性。
这是一项前瞻性研究，由一位作者对连续25例糖尿病患者入院时感染的伤口进行培养。分离株保存后，采用琼脂稀释法检测对10种口服抗菌药物的敏感性。
金黄色葡萄球菌是最常见的分离株（占患者的76%），25例患者伤口中有5例（20%）为耐甲氧西林金黄色葡萄球菌（MRSA）。链球菌、肠球菌、肠杆菌科细菌和厌氧菌在≥40%的患者伤口中也有发现。司帕沙星和左氧氟沙星是检测的活性最高的药物，对≥88%的分离株有活性。对司帕沙星和左氧氟沙星耐药的分离株包括MRSA、肠球菌和一些厌氧菌。按既往是否使用过抗生素分析，既往接受过口服抗生素治疗的患者伤口中更易分离出MRSA、肠球菌和铜绿假单胞菌，而分离出肠杆菌科细菌和厌氧菌的可能性较小。
MRSA和肠球菌现在是糖尿病足感染的常见病因，其患病率增加可能与抗菌药物的使用有关。这些伤口在初始门诊治疗时可能需要联合使用抗菌药物。新型氟喹诺酮类药物司帕沙星和左氧氟沙星是检测的活性最高的口服药物。
