scholarly journals The Influence of Multidrug-Resistant Bacteria on Clinical Outcomes of Diabetic Foot Ulcers: A Systematic Review

2021 ◽  
Vol 10 (9) ◽  
pp. 1948
Author(s):  
Gianmarco Matta-Gutiérrez ◽  
Esther García-Morales ◽  
Yolanda García-Álvarez ◽  
Francisco Javier Álvaro-Afonso ◽  
Raúl Juan Molines-Barroso ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Mortality Rates ◽  
Multidrug Resistant ◽  
Healing Time ◽  
Cochrane Library ◽  
Foot Ulcers ◽  
Resistant Organism ◽  
Diabetic Foot Ulcers ◽  
Multidrug Resistant Organisms

Multidrug-resistant organism infections have become important in recent years due to the increased prevalence of diabetic foot ulcers and their possible consequences. This study aimed to systematically review and evaluate ulcer duration, healing time, hospital stay, amputation, and mortality rates in patients with diabetic foot ulcers caused by infection with multidrug-resistant organisms. PubMed, the Cochrane Library, and Web of Science were searched in May 2020 to find observational studies in English about the clinical outcomes of multidrug-resistant organism infection in diabetic foot ulcers. Eight studies met the inclusion criteria, and these studies included 923 patients. The overall methodological quality of the study was moderate. Ulcer duration was described in six studies, and there was no practical association with multidrug-resistant organisms. Two out of three studies reported a longer healing time in multidrug-resistant organism infections than in non-multidrug-resistant organism infections. Clinical outcomes included the duration of hospitalisation, surgeries, amputations, and deaths. Lower limb amputation was the most reported clinical outcome in the included studies, and was more prevalent in the multidrug-resistant organism infections. We concluded that there was not enough evidence that multidrug-resistant organisms hindered the healing of diabetic foot ulcers. In contrast to the clinical outcomes, multidrug-resistant organisms affect both amputation rates and mortality rates.

scholarly journals MON-626 Frequency and Associated Factors with Multidrug-Resistant Organism Infection in Diabetic Foot Ulcers in a Peruvian Public Hospital

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Marlon Augusto Yovera-Aldana ◽  
Liset Paola Sifuentes ◽  
Delia Cruz-Estacio ◽  
Diana Consuelo Flores ◽  
Lucy Nelly Damas-Casani
Keyword(s):  
Clinical Practice ◽  
Diabetic Foot ◽  
Associated Factors ◽  
Public Hospital ◽  
Multidrug Resistant ◽  
Foot Ulcers ◽  
Bivariate Analysis ◽  
Resistant Organism ◽  
Diabetic Foot Ulcers ◽  
International Expert

Abstract Objective: To determine the frequency and associated factors with multidrug-resistant organism (MDRO) infection among patients with diabetic foot ulcers in a Peruvian Public Hospital. Materials and methods. Cross-sectional survey was conducted from January 2017 -December 2018 at National Hospital in Lima Perú. Ulcers with clinical signs of infection (erythema, edema, pain, purulent exudate) according Infectious Diseases Society of America clinical practice guideline were included1. Wounds with only skin involvement were excluded. On admission, specimens for culture were obtained after cleansing and debriding of the wound. Samples were promptly sent to the microbiology laboratory for culture using appropriate transport media. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 automated system (BioMérieux Laboratory, Argentina). Multidrug-resistant organisms were identified according to the recommendations of International Expert Proposal2. Prevalence ratios derived from bivariate analysis are given with their 95% CI, which was performed to study factors associated with the presence of multidrug-resistant bacteria; and a multivariate analysis with a lineal model to associated variables found in the bivariate analysis. This study has the approval of the Research Ethics Committee of the María Auxiliadora Hospital. Results Among 153 selected subjects, 75% were male, with an average age of 59 yo, 70% had ≥10 years of diabetes duration and only 16% had HbA1C <7%. A frequency of 85% of patients with MDRO infection was found and was associated with minor amputation RP 1.18 (95% CI 1.01-1.44) and with hospitalization time of ≥ 28 days RP 1.21 (95% CI 1.03-1.30). Conclusion. 6 of 7 patients have MDRO infection among patients with diabetic foot ulcers and are associated with the occurrence of minor amputation and hospitalization time ≥ 28 days. References 1. Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-73. 2. Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrugresistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

Therapeutic Properties of Honey for the Management of Wounds; Is There a Role in the Armamentarium of Diabetic Foot Ulcer Treatment? Results From In vitro and In vivo Studies

2021 ◽  
pp. 153473462110268
Author(s):  
Ioanna A. Anastasiou ◽  
Ioanna Eleftheriadou ◽  
Anastasios Tentolouris ◽  
Georgia Samakidou ◽  
Nikolaos Papanas ◽  
...  
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Diabetic Animal ◽  
Cochrane Library ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Diabetic Wound ◽  
Diabetic Wound Healing ◽  
Therapeutic Properties

Diabetic foot ulcers are one of the most dreadful complications of diabetes mellitus and efforts to accelerate diabetic wound healing are of paramount importance to prevent ulcer infections and subsequent lower-limb amputations. There are several treatment approaches for the management of diabetic foot ulcers and honey seems to be a safe and cost-effective therapeutic approach on top of standard of care. The aim of this review was to summarize the therapeutic properties of honey and the data regarding its possible favorable effects on diabetic wound healing. A literature search of articles from 1986 until April 2021 was performed using MEDLINE, EMBASE, and the Cochrane Library to assess for studies examining the therapeutic wound healing properties of honey, it's in vitro effect, and the efficacy and/or mechanism of action of several types of honey used for the treatment of diabetic animal wounds. Honey has antioxidant, anti-inflammatory, and antibacterial properties and in vitro studies of keratinocytes and fibroblasts, as well as studies in diabetic animal models show that treatment with honey is associated with increased re-epithelialization and collagen production, higher wound contraction, and faster wound healing. The use of honey could be a promising approach for the management of diabetic foot ulcers.

The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery

2021 ◽  
pp. 153473462110225
Author(s):  
Marta Carmena-Pantoja ◽  
Francisco Javier Álvaro-Afonso ◽  
Esther García-Morales ◽  
Yolanda García-Álvarez ◽  
Aroa Tardáguila-García ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Calcification ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Time To Recurrence ◽  
Artery Disease ◽  
Clinical Records

The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.

scholarly journals Clinical Outcomes for Diabetic Foot Ulcers Treated with Clostridial Collagenase Ointment or with a Product Containing Silver

2018 ◽  
Vol 7 (10) ◽  
pp. 339-348 ◽  
Author(s):  
Travis A. Motley ◽  
Joseph M. Caporusso ◽  
Darrell L. Lange ◽  
Robert A. Eichelkraut ◽  
David Innes Cargill ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers

scholarly journals Alternative Approaches for the Management of Diabetic Foot Ulcers

2021 ◽  
Vol 12 ◽  
Author(s):  
Cassandra Pouget ◽  
Catherine Dunyach-Remy ◽  
Alix Pantel ◽  
Adeline Boutet-Dubois ◽  
Sophie Schuldiner ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Current Knowledge ◽  
Healing Process ◽  
Public Health Problem ◽  
Skin Surface ◽  
Multidrug Resistant ◽  
Limb Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Alternative Approaches

Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.

scholarly journals Risk factors for the diabetic foot infection with multidrug-resistant microorganisms in South India

2018 ◽  
Vol 5 (2) ◽  
pp. 675 ◽  
Author(s):  
Manikandan Kathirvel ◽  
Viswakumar Prabakaran ◽  
Jayalakshmi Jayarajan ◽  
Ajay Sivakumar ◽  
Vimalkumar Govindan
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Previous History ◽  
Multidrug Resistant ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Recurrent Ulcer ◽  
Multidrug Resistant Organisms ◽  
Recurrent Ulcers

Background: To analyse the risk-factors contributing to infection with multidrug-resistant organisms.Methods: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analyzed for each patient. Using internationally accepted criteria, the multidrug-resistant organisms were identified. Risk factors for acquiring MDRO infection were identified using appropriate statistical tools.Results: MDRO were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug-resistant organisms. By univariate analysis poor glycaemic control, previous hospitalisation, previous history of amputation, previous antibiotic usage, size of the ulcer, necrotic ulcer, recurrent ulcers, higher grade of ulcer, the presence of osteomyelitis, the presence of retinopathy, peripheral vascular disease, neuropathy and polymicrobial culture, were significantly associated with MDRO infected foot ulcers. Analysis by logistic regression indicated that only two factors significantly increased the risk of acquiring MDRO infection. They are recurrent ulcer (OR = 3.39, p <0.05, 95% CI = 1.081-10.664) and higher grade of ulcer (OR = 13.44, p <0.001, 95 % CI =3.595-50.278).Conclusions: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire MDROs.

Insight into multidrug-resistant microorganisms from microbial infected diabetic foot ulcers

2019 ◽  
Vol 13 (2) ◽  
pp. 1261-1270 ◽  
Author(s):  
Mohamed A. Hassan ◽  
Tamer M. Tamer ◽  
Asmaa A. Rageh ◽  
Alaa M. Abou-Zeid ◽  
Eman H.F. Abd El-Zaher ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Multidrug Resistant ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Insight Into
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