The Microbial Diversity and Antimicrobial Susceptibility Profile Underlying Diabetic Foot Osteomyelitis: A Retrospective Study Conducted in North Queensland, Australia.

Foot & Ankle Orthopaedics Pub Date : 2024-09-30 eCollection Date: 2024-07-01 DOI:10.1177/24730114241281503

Nandini Kulasegaran, Venkat Vangaveti, Robert Norton, Usman Malabu

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Abstract

Background: Diabetic foot osteomyelitis (DFO) commonly occurs secondary to ulcerations of the skin. Empirical antibiotic agents are a key element of treatment and their use is dependent on local knowledge of the microbial spectrum of diabetic foot infections. This study aimed to retrospectively analyze the local microbiological profile, including bacterial culture/sensitivity results of DFO, and compare findings with literature. This study also aimed to review the concordance of microbiology results with national guidelines for the future treatment of DFO.

Methods: A retrospective review of clinical records was performed on patients who presented to the high-risk foot clinic, Townsville University Hospital, between 2018 and 2022. All patients older than 18 years and diagnosed with DFO were included. Our exclusion criteria included all other foot presentations, including trauma, vasculitis, and neoplasms.

Results: On the basis of the inclusion and exclusion criteria, 124 patients with DFO were selected. Most patients in the cohort were males (70.2%), non-Indigenous (68.5%), aged 50-69 years (55.6%), and with elevated HbA_1c levels (>8.6). Chronic kidney disease (39.5%) and ischemic heart disease (41.9%) were common comorbidities. Of the pertinent microbial results, Staphylococcus aureus (~76%) was the most commonly isolated Gram-positive organism. Gram-positive bacteria were significantly increased in the elderly population with DFO (P < .05). All methicillin-resistant S aureus isolates were vancomycin- and cotrimoxazole-sensitive. Pseudomonas aeruginosa was the predominant Gram-negative organism isolated (39.3%). P aeruginosa exhibited low sensitivity to ciprofloxacin.

Conclusion: This study has enhanced our understanding of the various microbial species underlying DFO at our center and may be generalizable.

Level of evidence: Level IV, retrospective case series.

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糖尿病足骨髓炎的微生物多样性和抗菌药敏感性概况：在澳大利亚北昆士兰进行的一项回顾性研究。

背景：糖尿病足骨髓炎（DFO）通常继发于皮肤溃疡。经验性抗生素是治疗的关键因素，其使用取决于当地对糖尿病足感染微生物谱的了解。本研究旨在回顾性分析当地的微生物谱，包括 DFO 的细菌培养/药敏结果，并将结果与文献进行比较。本研究还旨在审查微生物学结果与国家指南的一致性，以便今后治疗 DFO：对2018年至2022年期间到汤斯维尔大学医院高危足病门诊就诊的患者的临床记录进行了回顾性审查。所有年龄超过 18 岁并被诊断为 DFO 的患者均被纳入其中。我们的排除标准包括所有其他足部症状，包括创伤、血管炎和肿瘤：根据纳入和排除标准，共筛选出 124 名 DFO 患者。大多数患者为男性（70.2%）、非土著人（68.5%）、50-69 岁（55.6%）和 HbA1c 水平升高（>8.6）。慢性肾病（39.5%）和缺血性心脏病（41.9%）是常见的合并症。在相关微生物结果中，金黄色葡萄球菌（约占 76%）是最常见的革兰氏阳性菌。在患有 DFO 的老年人群中，革兰氏阳性菌明显增多（P < .05）。所有耐甲氧西林金黄色葡萄球菌均对万古霉素和复方新诺明敏感。铜绿假单胞菌是主要的革兰氏阴性菌（39.3%）。铜绿假单胞菌对环丙沙星的敏感性较低：本研究加深了我们对本中心 DFO 潜在的各种微生物种类的了解，并可能具有普遍性：证据等级：IV级，回顾性病例系列。

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