Nese Saltoglu1, Onder Ergonul2, Necla Tulek3, Mucahit Yemisen4, Ayten Kadanali5, Gul Karagoz5, Ayse Batirel6, Oznur Ak6, Cagla Sonmezer3, Haluk Eraksoy7, Atahan Cagatay7, Serkan Surme4, Salih A Nemli8, Tuna Demirdal8, Omer Coskun9, Derya Ozturk10, Nurgul Ceran10, Filiz Pehlivanoglu11, Gonul Sengoz11, Turan Aslan12, Yasemin Akkoyunlu13, Oral Oncul14, Hakan Ay14, Lutfiye Mulazımoglu15, Buket Erturk15, Fatma Yilmaz16, Gulsen Yoruk17, Nuray Uzun18, Funda Simsek19, Taner Yildirmak19, Kadriye Kart Yaşar11, Meral Sonmezoglu20, Yasar Küçükardali20, Nazan Tuna21, Oguz Karabay21, Nail Ozgunes16, Fatma Sargın16. 1. Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. Electronic address: saltoglu@istanbul.edu.tr. 2. Koc University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 3. Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 4. Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 5. Umraniye Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 6. Kartal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 7. Istanbul University, Istanbul Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 8. İzmir Atatürk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmır, Turkey. 9. GATA Ankara Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey. 10. Haydarpaşa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 11. Haseki Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 12. Bezmi Alem University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 13. Bezmi Alem University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey; Gulhane Haydarpaşa Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 14. Gulhane Haydarpaşa Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 15. Marmara University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 16. Medeniyet University Medical Faculty, Goztepe Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 17. Samatya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 18. Sisli Etfal Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 19. Okmeydanı Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 20. Yeditepe Üniversity Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey. 21. Sakarya University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
Abstract
OBJECTIVES: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms. METHODS: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). CONCLUSION: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.
OBJECTIVES: We described the clinical outcomes of the diabeticpatients who had foot infections with multidrug resistant organisms. METHODS: We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge. RESULTS: In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19-90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82-38.15, p=0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24-47.96, p=0.028), and chronic heart failure (OR: 3, CI: 1.01-9.04, p=0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p<0.001). CONCLUSION: Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.
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