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Oleh: Arinda Stefani Ayu Wulandari Dicky Auliansyah Thoriq Aziz

1) Staphylococcus aureus is the most common pathogen causing diabetic foot infections, along with Streptococcus, Enterococcus, and Enterobacteriaceae. Methicillin-resistant S. aureus is a growing concern. 2) Antibiotics should not be prescribed for clinically uninfected wounds. Empirical antibiotic selection depends on infection severity and local antimicrobial resistance patterns. 3) Narrow-spectrum oral antibiotics are suitable for mild infections while broad-spectrum intravenous antibiotics are recommended for severe or moderate infections. Targeting multidrug-resistant organisms like MRSA is important.

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Vincha Rahma
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19 views14 pages

Oleh: Arinda Stefani Ayu Wulandari Dicky Auliansyah Thoriq Aziz

1) Staphylococcus aureus is the most common pathogen causing diabetic foot infections, along with Streptococcus, Enterococcus, and Enterobacteriaceae. Methicillin-resistant S. aureus is a growing concern. 2) Antibiotics should not be prescribed for clinically uninfected wounds. Empirical antibiotic selection depends on infection severity and local antimicrobial resistance patterns. 3) Narrow-spectrum oral antibiotics are suitable for mild infections while broad-spectrum intravenous antibiotics are recommended for severe or moderate infections. Targeting multidrug-resistant organisms like MRSA is important.

Uploaded by

Vincha Rahma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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MICROBIOLOGY AND

ANTIMICROBIAL THERAPY
FOR DIABETIC FOOT
INFECTIONS
P E R C E P TO R :
D R . H E L M I , S P. O T
Oleh:
Arinda Stefani
Ayu Wulandari
Dicky Auliansyah
Thoriq Aziz
KEPANITERAAN KLINIK
RSUD ABDOEL MOELOEK
FAKULTAS KEDOKTERAN
UNIVERSITAS LAMPUNG
2019
ABSTRACT
In addition to being the prime factor associated with amputation, diabetic foot infections (DFIs) are associated with
major morbidity, increasing mortality, and reduced quality of life. The choice of appropriate antibiotics is very important
in order to reduce treatment failure, antimicrobial resistance, adverse events, and costs. We reviewed articles on
microbiology and antimicrobial therapy and discuss antibiotic selection in Korean patients with DFIs. Similar to Western
countries, Staphylococcus aureus is the most common pathogen, with Streptococcus, Enterococcus, Enterobacteriaceae and
Pseudomonas also prevalent in Korea. It is recommended that antibiotics are not prescribed for clinically uninfected
wounds and that empirical antibiotics be selected based on the clinical features, disease severity, and local antimicrobial
resistance patterns. Narrow-spectrum oral antibiotics can be administered for mild infections and broad-spectrum
parenteral antibiotics should be administered for some moderate and severe infections. In cases with risk factors for
methicillin-resistant S. aureus or Pseudomonas, empirical antibiotics to cover each pathogen should be considered. The
Health Insurance Review and Assessment Service standards should also be considered when choosing empirical
antibiotics. In Korea, nationwide studies need to be conducted and DFI guidelines should be developed.

Key Words: Diabetic foot; Infections; Microbiology; Antibiotics


INTRODUCTION

• Up to one-third of people with diabetes develop a diabetic foot ulceration (DFU) during their
lifetime and over 50% of these ulcerations become infected [1].
• Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality,high
costs, increased risk of lower extremity amputation (LEA), and reduced quality of life [2].
• Staphylococcus aureus and Pseudomonas aeruginosa are important causative microorganisms in
DFIs. The distributions of these causative organisms differ geographically and according to the
illness duration, prior antibiotic use, and the relevance of nosocomial infections [9]
MICROBIOLOGY
1. SPECIMEN COLLECTION

• Bacterial culture is not recommended for clinically uninfected wounds except when necessary
to determine the presence of multi-drug resistant microorganisms and isolate patients [6,11].
• Because most mild acute infections in patients who have not recently been treated with
antibiotics are caused only by aerobic Gram-positive cocci, predominantly S. aureus and/or, to a
lesser degree, β-hemolytic streptococci, wound cultures may be unnecessary in these
infections.
• In order to increase the sensitivity of the culture results, it is recommended that samples be
taken before empirical antimicrobial therapy or, when antimicrobials are already used, after
they could be discontinued for several days and samples collected if the patients are stable [6,
11].
2. CAUSATIVE MICROORGANISM

• Skin commensals such as coagulase-negative staphylococci, Corynebacterium, or Micrococcus from


swab cultures are not usually considered true pathogens, although they may grow repeatedly or
from reliable specimens.
• In most centers, including Korea, S. aureus is the most frequently isolated, and perhaps most virulent
pathogen, whether alone or in combination [11].
• Aerobic Gram-positive cocci, especially S. aureus and Streptococcus species, are the predominant
pathogens in DFIs and usually cause monomicrobial infection in previously untreated acute
infections [9, 14, 23].
• Polymicrobial infections, which may include various types of aerobes such as S. aureus, Streptococcus,
Enterococcus, Enterobacteriaceae, and Pseudomonas commonly appear in deep or chronic wounds [11,
24]
3. Antimicrobial resistance
• Methicillin-resistant S. aureus (MRSA) is more often isolated from patients who have recently
received antibiotic therapy, have been previously hospitalized, have nasal carriage of MRSA or
osteomyelitis, or have a long wound duration (≥4 weeks) [38,39].
• The majority of studies in the 1990s and 2000s reported a 15–30% prevalence of MRSA among
patients with DFIs [38].
• The burden of MRSA has dramatically increased in many countries since the late 1990s, but it has
recently been declining globally, especially in high-income countries, concomitant with improved
hospital infection control measures [40-43].
• Multi-drug resistant (MDR) Gram-negative microorganisms, including extended-spectrum beta-
lactamase (ESBL) or carbapenemase- producing Enterobacteriaceae and MDR non-fermenters, are
becoming a serious concern in tertiary referral hospitals in developing countries [10, 25, 50-52].
ANTIMICROBIAL TREATMENT
1. SEVERITY ASSESSMENT
• Assessing the severity of DFIs is crucial in determining the need for hospitalization, the choice
of empirical antibiotics (broad-spectrum intravenous antibiotics or narrow-spectrum oral
antibiotics), and the potential necessity and timing of foot surgery and the possibility of
amputation.
• The IDSA and IWGDF have established criteria to assess the severity of DFIs
2. ANTIBIOTICS ADMINISTRATION

• Empirical antibiotics are initially selected based on the clinical


features, disease severity, and local antimicrobial resistance patterns
in the patients with DFIs.
• Narrow-spectrum oral antibiotics can be administered for mild
infections and broad-spectrum parenteral antibiotics administered
for to severe infections.
• Oral or parenteral antibiotics can be administered for moderate
infections according to the patient’s circumstances.
• This guideline also recommended that empirical antibiotics targeting MRSA be considered in
necrotizing fasciitis because of its serious progression and high mortality rate.
• It is better to use oral empirical antibiotics targeting MRSA for mild and some moderate DFIs
with risk factors for MRSA and parenteral empirical antibiotics targeting MRSA in severe
infections with risk factors for MRSA.
CONCLUSION
The implementation of an antimicrobial stewardship program is suggested to reduce
the inappropriate and unnecessary use of antibiotics in DFIs.

Antibiotic recommendations for the empirical treatment of diabetic foot infections


THANK YOU

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