Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 5 , ISSUE 2 ( December, 2018 ) > List of Articles


Outcome in Patients of Diabetic Foot Infection with Multidrug Resistant Organisms

Jagdish Chander, Sanjay Gupta, Ashok Attri, Sudhansoo Khanna, Mayankjayant

Keywords : Diabetic foot infection, Methicillin-resistant S. aureus, Multidrug-resistant organisms

Citation Information : Chander J, Gupta S, Attri A, Khanna S, M. Outcome in Patients of Diabetic Foot Infection with Multidrug Resistant Organisms. J Foot Ankle Surg Asia-Pacific 2018; 5 (2):51-55.

DOI: 10.5005/jp-journals-10040-1089

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Aim and objectives: To study the spectrum of microorganisms in patients of diabetic foot infection (DFI) and to evaluate the outcome in patients of DFI with multidrug resistant organisms (MDRO). Materials and methods: A total of 116 patients, visiting diabetic foot clinic of our institute with DFI were observed in a prospective manner. Diagnosis of infection was based on clinical findings using International Working Group on Diabetic Foot and Infection Diseases Society of America (IWGDF-IDSA). The microbiological profile of wound assessed at the time of admission and patients were followed up for wound healing rate, need for amputation and surgical interventions, hospital stay, and mortality for 6 months. Observation and results: The microbiological profile of our patients showed that Gram-negative microorganisms were commonly isolated (78.4%) from our patients. The culture trends revealed that most common isolates were E. coli (33.6%), Pseudomonas (19.8%), Proteus (18%), Klebsiella (16%), Acinetobacter and Citrobacter among the Gram-negative organisms. Among Gram-positive organisms, Staphylococcus aureus was the most common isolate which was present in 29 (25%) of the patients. MDRO were isolated from 13.8% of patients. Most common MDRO isolated were methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococci (VRE). The outcome was assessed in terms of mortality rate, the rate of major amputation, rate of minor amputation, the rate of multiple surgical interventions, duration of hospitalisation and requirement of intensive care unit (ICU) admission, re-admission rate, antibiotic requirement which were not significantly different in patients with MDRO than that with non-MDRO (p-value > 0.05). The mean healing rate in patients with MDRO was not significantly different than that from patients with non-MDRO (p-value > 0.05). Conclusion: Although the number of patients with MDRO is small as compared to non-MDRO, the study found that MDRO has no significance on the outcome of the patients with DFI.

PDF Share
  1. Lavery LA, Armstrong DG, Murdock DP, Peters EJ, Lipsky BA. Validation of the infectious diseases society of America's diabetic foot infection classification system. Clin Infect Dis 2007 Feb;44:562-565.
  2. Lipsky BA, Berendt AR, Deery HG, Embel JM, Joseph WS, Karchner AW et al. Infectious Diseases Society of America diagnosis and treatment of diabetic foot infection. Clin Infect Dis 2004 Oct;39:885-910.
  3. Siegel JD, Rhinehart E, Jackson, Chiarello L. Management of Multidrug-Resistant Organisms In Healthcare Settings 2006. Accessed 13 July 2017.
  4. Eleftheriadou I, Tentolouriis N, Argiana V, Jude E, Boulton AJ. Methicillin-resistant Staphylococcus aureus in diabetic foot infections. Drugs 2010 Oct;70:1785-1797.
  5. Harteman-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard JL, Jarlier V. Diabetic foot ulcer and multidrugresistant organisms: risk factors and impact. Diabetic Med 2004 Jul;21:710-715.
  6. Eckman MH, Greenfield S, Mackey WC, Wong JB, Kaplan S, Sullivan L, et al. Foot infections in diabetic patients, decision and cost-effectiveness analysis. JAMA 1995 Mar;273:712-20.
  7. Verma S, Joshi S, Chitnis V, Hemwani N, Chitnis D. Growing problem of methicillin resistant staphylococci-Indian scenario. Indian J Med Sci 2000 Dec;54:535-540.
  8. Abramson MA, Sexton DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs. Infect Control Hosp Epidemiol 1999 Jun;20:408-411.
  9. Rello J, Torres A, Ricart M, Valles J, Gonzalez J, Artigas A et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 1994 Dec;150:1545- 1549.
  10. Soriano A, Martinez JA, Mensa J, Marco F, Almela M, Moreno- Martinez A et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000 Feb;30:368-373.
  11. Harbarth S, Rutschmann O, Sudre P, Pittet D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998 Jan; 158:182-189.
  12. Sanchez JA, Martýnez JLL, Marrero YQ, Herrero MJH, Morales EG, Galvan JJC, et al. Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series. Diabet Med 2009 May;26:552- 555. 13.. Richard JL, Sotto A, Jourdan N, Combesecure C, Vannereau D, Rodier M, et al. Risk factors and healing impact of multidrugresistant bacteria in diabetic foot ulcers. Diabetes Med 2008 Sep; 34:363-369.
  13. Gadepalli R, Dhawan B, Sreeenivasan V, Kapil A, Ammini AC, Chaudhary R. A clinico-microbioloical study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006 Aug; 29:1727-1732.
  14. Dang CN, Prasad YDM, Boulton AJM, Jude EB. Methicillinresistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 2003 Feb; 20:159-161.
  15. Lavery LA, Fontaine JL, Bhavan K, Kim PJ, Williams JR, Hunt NA. Risk factors for methicillin-resistant Staphylococcus aureus in diabetic foot infections. Diabetic foot ankle 2014 Apr;5:23575.
  16. Harteman-Heurtier A, Robert J, Jacqueminet S, Ha Van G, Golmard JL, Jarlier V, et al. Diabetic foot ulcer and multidrugresistant- organisms: risk factors and impact. Diabet Med 2004 Jul;21:710-715.
  17. Game FL, Boswell T, Soar C, Houghton E, Treece KA, Pound M, et al. Outcome of diabetic foot ulcers with and without Staphylococcus aureus (MRSA). Diabet Med 2003 Jul;20:30.
  18. Mizobuchi S, Minami J, Jin F, Matsushita O, Okabe A. Comparison of the virulence of methicillin-resistant and methicillin- sensitive Staphylococcus aureus. Microbiol Immunol 1994 Aug;38:599-605.
  19. Tentolouris N, Jude EB, Smirnof I, Knowles EA, Boulton AJ. Methicillin-resistant Staphylococcus aureus: an increasing problem in diabetic foot clinic. Diabet Med 1999 Sep;16:767- 771.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.