1887

Abstract

A retrospective case–control study of 118 (male : female, 68 : 50) Chinese type 2 diabetic patients with foot ulcers (Wagner's grade 3–5) was conducted to determine the prevalence and risk factors for meticillin-resistant (MRSA) infection in relation to the original community or hospital parameters. Ulcer specimens were processed for Gram staining, aerobic culture and antimicrobial susceptibility testing. species were tested for meticillin resistance using oxacillin. was the most frequent pathogen (25.6 %) in diabetic patient specimens (160 isolates), and a high proportion of isolates were MRSA (63.4 %). A high percentage of isolates (65.4 %) satisfied the definition for hospital-associated MRSA (HA-MRSA) infection. The size of ulcers [adjusted odds ratio (OR) 1.61; 95 % confidence interval (CI) 1.22–2.12] and osteomyelitis (adjusted OR 18.51, 95 % CI 2.50–137.21) were independent predictors of MRSA infection. The HA-MRSA group had a significantly different distribution from the community-associated MRSA group with respect to age, history of diabetes and length of hospital stay (all <0.001). Neuropathy, vascular disease (all =0.049) and osteomyelitis (=0.026) were the most common underlying conditions observed in the HA-MRSA group. This study contributes to the establishment of precautions against the emergence of MRSA including MRSA acquired from different sources among the Chinese population with diabetic foot ulcers based on their original or clinical parameters.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.020537-0
2010-10-01
2020-01-27
Loading full text...

Full text loading...

/deliver/fulltext/jmm/59/10/1219.html?itemId=/content/journal/jmm/10.1099/jmm.0.020537-0&mimeType=html&fmt=ahah

References

  1. Aragón-Sánchez, J., Lázaro-Martínez, J. L., Quintana-Marrero, Y., Hernández-Herrero, M. J., García-Morales, E., Cabrera-Galván, J. J. & Beneit-Montesinos, J. V. ( 2009; ). Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series. Diabet Med 26, 552–555.[CrossRef]
    [Google Scholar]
  2. Baba, T., Takeuchi, F., Kuroda, M., Yuzawa, H., Aoki, K., Oguchi, A., Nagai, Y., Iwama, N., Asano, K. & other authors ( 2002; ). Genome and virulence determinants of high virulence community-acquired MRSA. Lancet 359, 1819–1827.[CrossRef]
    [Google Scholar]
  3. Dang, C. N., Prasad, Y. D., Boulton, A. J. & Jude, E. B. ( 2003; ). Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med 20, 159–161.[CrossRef]
    [Google Scholar]
  4. Embil, J. M., Rose, G., Trepman, E., Math, M. C., Duerksen, F., Simonsen, J. N. & Nicolle, L. E. ( 2006; ). Oral antimicrobial therapy for diabetic foot osteomyelitis. Foot Ankle Int 27, 771–779.
    [Google Scholar]
  5. Fridkin, S. K., Hageman, J. C., Morrison, M., Sanza, L. T., Como-Sabetti, K., Jernigan, J. A., Harriman, K., Harrison, L. H., Lynfield, R. & other authors ( 2005; ). Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 352, 1436–1444.[CrossRef]
    [Google Scholar]
  6. Game, F. & Jeffcoate, W. ( 2004; ). MRSA and osteomyelitis of the foot in diabetes. Diabet Med 21, 16–19.
    [Google Scholar]
  7. Goldstein, E. J., Citron, D. M. & Nesbit, C. A. ( 1996; ). Diabetic foot infections. Bacteriology and activity of 10 oral antimicrobial agents against bacteria isolated from consecutive cases. Diabetes Care 19, 638–641.[CrossRef]
    [Google Scholar]
  8. Hartemann-Heurtier, A., Robert, J., Jacqueminet, S., Ha, V. G., Golmard, J. L., Jarlier, V. & Grimaldi, A. ( 2004; ). Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet Med 21, 710–715.[CrossRef]
    [Google Scholar]
  9. Kessler, L., Piemont, Y., Ortega, F., Lesens, O., Boeri, C., Averous, C., Meyer, R., Hansmann, Y., Christmann, D. & other authors ( 2006; ). Comparison of microbiological results of needle puncture vs. superficial swab in infected diabetic foot ulcer with osteomyelitis. Diabet Med 23, 99–102.[CrossRef]
    [Google Scholar]
  10. Lipsky, B. A., Pecoraro, R. E., Larson, S. A., Hanley, M. E. & Ahroni, J. H. ( 1990; ). Outpatient management of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med 150, 790–797.[CrossRef]
    [Google Scholar]
  11. Lipsky, B. A., Berendt, A. R., Embil, J. & De Lalla, F. ( 2004; ). Diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev 20, S56–S64.[CrossRef]
    [Google Scholar]
  12. Mantey, I., Hill, R. L., Foster, A. V., Wilson, S., Wade, J. J. & Edmonds, M. E. ( 2000; ). Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients. Commun Dis Public Health 3, 288–290.
    [Google Scholar]
  13. Naimi, T. S., LeDell, K. H., Como-Sabetti, K., Borchardt, S. M., Boxrud, D. J., Etienne, J., Johnson, S. K., Vandenesch, F., Fridkin, S. & other authors ( 2003; ). Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 290, 2976–2984.[CrossRef]
    [Google Scholar]
  14. NCCLS ( 2002; ). Performance Standards for Antimicrobial Susceptibility Testing; 12th Informational Supplement. M100-S12. Wayne, PA: National Committee for Clinical Laboratory Standards.
  15. Pellizzer, G., Strazzabosco, M., Presi, S., Furlan, F., Lora, L., Benedetti, P., Bonato, M., Erle, G. & de Lalla, F. ( 2001; ). Deep tissue biopsy vs. superficial swab culture monitoring in the microbiological assessment of limb-threatening diabetic foot infection. Diabet Med 18, 822–827.[CrossRef]
    [Google Scholar]
  16. Perry, C. R., Pearson, R. L. & Miller, G. A. ( 1991; ). Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis. J Bone Joint Surg Am 73, 745–749.
    [Google Scholar]
  17. Senneville, E., Melliez, H., Beltrand, E., Legout, L., Valette, M., Cazaubiel, M., Cordonnier, M., Caillaux, M., Yazdanpanah, Y. & Mouton, Y. ( 2006; ). Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 42, 57–62.[CrossRef]
    [Google Scholar]
  18. Senneville, E., Lombart, A., Beltrand, E., Valette, M., Legout, L., Cazaubiel, M., Yazdanpanah, Y. & Fontaine, P. ( 2008; ). Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care 31, 637–642.[CrossRef]
    [Google Scholar]
  19. Shankar, E. M., Mohan, V., Premalatha, G., Srinivasan, R. S. & Usha, A. R. ( 2005; ). Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med 16, 567–570.[CrossRef]
    [Google Scholar]
  20. Tentolouris, N., Jude, E. B., Smirnof, I., Knowles, E. A. & Boulton, A. J. ( 1999; ). Methicillin-resistant Staphylococcus aureus: an increasing problem in a diabetic foot clinic. Diabet Med 16, 767–771.[CrossRef]
    [Google Scholar]
  21. Tentolouris, N., Petrikkos, G., Vallianou, N., Zachos, C., Daikos, G. L., Tsapogas, P., Markou, G. & Katsilambros, N. ( 2006; ). Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers. Clin Microbiol Infect 12, 186–189.[CrossRef]
    [Google Scholar]
  22. Wagner, F. W., Jr ( 1981; ). The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 2, 64–122.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.020537-0
Loading
/content/journal/jmm/10.1099/jmm.0.020537-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error