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The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

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dc.contributor.authorSaltoğlu, Neşe
dc.contributor.authorSürme, Serkan
dc.contributor.authorEzirmik, Elif
dc.contributor.authorKadanalı, Ayten
dc.contributor.authorKurt, Ahmet Furkan
dc.contributor.authorÖzdemir, Meryem Şahin
dc.contributor.authorAk, Öznur
dc.contributor.authorAltay, Fatma Aybala
dc.contributor.authorAcar, Ali
dc.contributor.authorÇakar, Zeynep Şule
dc.contributor.authorTülek, Necla
dc.contributor.authorKınıklı, Sami
dc.contributor.authorKLIMIK Society
dc.contributor.authorDiabetic Foot Study Group
dc.date.accessioned2023-12-20T07:00:46Z
dc.date.available2023-12-20T07:00:46Z
dc.date.issued2023
dc.descriptionOpen Access, Published by The International Journal of Lower Extremity Wounds, https://doi.org/10.1177/15347346211004141, Nese Saltoglu, MD1 , Serkan Surme, MD 1 , Elif Ezirmik, MD2 , Ayten Kadanali, MD 3,4, Ahmet Furkan Kurt, MD 1 ,Meryem Sahin Ozdemir, MD1 , Oznur Ak, MD 5,6, Fatma Aybala Altay, MD7 ,Ali Acar, MD 7,8, Zeynep Sule Cakar, MD 4 , Necla Tulek, MD 8,9 ,Sami Kinikli, MD 9 , and KLİ MİK Society, Diabetic Foot Study Group; 1 Istanbul University-Cerrahpasa, Istanbul, Turkey 2 Istanbul University, Istanbul, Turkey 3 Biruni University, Medical School, Istanbul, Turkey 4 University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey 5 Dumlupinar University, Kutahya, Turkey 6 University of Health Sciences, Kartal Education and Research Hospital, Istanbul, Turkey 7 University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey 8 Atilim University, Ankara, Turkey 9 University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
dc.description.abstractWe aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 ± 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection (p = .043) and vancomycin treatment (p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency (p = .004), hospital readmission (p = .009), C-reactive protein > 130 mg/dL (p = .007), and receiving carbapenems (p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials.
dc.identifier.citationhttp://hdl.handle.net/20.500.14411/1913
dc.identifier.issn1552-6941
dc.identifier.urihttps://doi.org/10.1177/15347346211004141
dc.language.isoen
dc.publisherThe International Journal of Lower Extremity Wounds
dc.relation.ispartofseries22; 2
dc.subjectDiabetic foot infection, antimicrobial resistance, multidrug-resistant organisms, reinfection, major amputation
dc.titleThe Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection
dc.typeArticle
dspace.entity.typeArticle

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