Antibiotic resistance in diabetic foot infection and how to change its pattern before and during COVID-19 epidemic

Hamidreza Gilasi ©, Behin Omidi

Antibiotic resistance in diabetic foot infection and how to change its pattern before and during COVID-19 epidemic

کد: G-97035

نویسندگان: Hamidreza Gilasi ©, Behin Omidi

زمان بندی: زمان بندی نشده!

برچسب: میکروب شناسی

دانلود: دانلود پوستر

خلاصه مقاله:

Background and Aim

The development of diabetic foot infection (DFI) is strictly associated with an open wound, but other risk factors include peripheral neuropathy and arteriopathy, diabetes-related immune dysfunction, renal impairment and the chronic course of the wound itself . The specimens underwent gram staining and inoculation on both selective and non-selective media including MacConkey agar , blood agar, chocolate agar and 5% (v/v) BA supplemented with vitamin K1 (1 μg/ml), gentamicin (75 μg/ml) (GBA) and haemin (5 μg/ml). The inoculated plates were incubated under conducive atmospheric conditions for 24–48 h to enable bacterial isolation. Isolated organisms were identified by traditional microbiological methods. in 2020 the patients’ mean age was lower significantly. more patients in 2020 had history of previous ulcers. a higher rate of antibiotic resistance was detected in 2020. according to the IDSA/IWGDF classification, the prevalence of severe infections was significantly higher in 2020 The most common microbial isolates in Gram-positive bacteria were Staphylococcus aureus , Gramnegative bacteria was Pseudomonas aeruginosa and Anaerobes was Bacteroides species respectively. Among antibiotic resistance risk factors, there was a higher rate of domiciliary antibiotic therapies, which were often selfadministered in the 2020 group of patients. antibiotics may determine adverse effects or toxic reactions.

Methods

The diagnosis of infection was performed by both clinical signs and soft tissues’ and/or bone’s biopsy. The University of Texas Classification System was used to classify the ulcers, whereas the IDSA/IWGDF classification was used to define the severity of the infections. The classifications of wounds were according to the severity which was mild, moderate or severe based on the size, depth and level of the tissue involved in the infection, presence of metabolic instability or any systemic manifestations of infection. The specimen cultures were obtained once the wound surface had been irrigated with copious normal saline, and we subsequently debrided the superficial tissue and separated them from the exudates to isolate the colonizing pathogenic flora. Specimens were obtained by curetting the ulcer base post debridement and by aspirating the infected skin or deep tissues. The specimens underwent gram staining and inoculation on both selective and non-selective media including MacConkey agar, blood agar (BA, Basingstoke, UK), chocolate agar and 5% (v/v) BA supplemented with vitamin K1 (1 μg/ml), gentamicin (75 μg/ml) (GBA) and haemin (5 μg/ml). The inoculated plates were incubated under conducive atmospheric conditions for 24–48 h to enable bacterial isolation. Isolated organisms were identified by traditional microbiological methods.

Results

in 2020 the patients’ mean age was lower significantly. more patients in 2020 had history of previous ulcers. a higher rate of antibiotic resistance was detected in 2020. according to the IDSA/IWGDF classification, the prevalence of severe infections was significantly higher in 2020. The most common microbial isolates in Gram-positive bacteria were Staphylococcus aureus , Gramnegative bacteria was Pseudomonas aeruginosa and Anaerobes was Bacteroides species respectively.

Conclusion

Among antibiotic resistance risk factors, there was a higher rate of domiciliary antibiotic therapies, which were often selfadministered in the 2020 group of patients. This was also confirmed by the logistic regression analysis, which identified history of prior hospitalization, antibiotic selfadministration and antibiotic prescription by general practitioners as independent predictors of antibiotic resistance in these cohorts of patients. Moreover, antibiotic resistant infections usually require the administration of specific antibiotics and the hospitalization, which is itself a notorious risk factor for antibiotic resistance. Furthermore, antibiotics may determine adverse effects or toxic reactions, which may be responsible for the worsening of the systemic clinicalconditions and a dangerous reduction of patient’s compliance to the therapy .

Keywords

Diabetic foot infection; Antibiotic resistance; Amputation; Diabetic foot ulcer; Bacteriology profile; Microbial sensitivity tests

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