In diabetic foot infection, causative pathogens differ in Western population as compared with Asian population. The aim of this study is to analyze microbiological data with respect to diabetic foot infection in Korea to help the choice adequate empirical antibiotics.
We enrolled 745 patients with diabetic foot infection, who were admitted to diabetic wound center of the Korea University Guro Hospital between January 2011 and December 2015. Deep tissue and/or bone biopsy cultures were taken during surgical debridement in the operating room and microbiological analysis was performed.
Out of the 745 patients, 613 patients (82.2%) had isolated causative organisms and 832 microbial isolates were identified. Gram-positive aerobic bacteria were isolated in 57.5%, followed by Gram-negative aerobic bacteria (40.0%), anaerobes (1.4%), and fungus (1.1%). MRSA found most frequently identified (13.7%) in Gram-positive aerobes and Pseudomonas found most frequently identified (9.4%) in Gram-negative aerobes.
Microbiologic analysis in Korea differs from the reports from Western population. We propose the need of our own guidelines based on microbiology of Korea for better treatment.
Diabetes mellitus is a serious health problem that is rapidly expanding worldwide. In 2000, according to the World Health Organization, at least 171 million people worldwide suffered from diabetes and due to increasing rates, this number is projected to double by 2030 [
When surgeons are confronted with diabetic foot infection in clinics, they choose the management strategy using antibiotics or surgical debridement. Current clinical guidelines for the management of DFI, according to Infectious Disease Society of America (IDSA), recommend empirical antimicrobial treatment until wound cultures ascertain the causative pathogens and their antibiotic susceptibility patterns, allowing targeted antibiologic treatment [
The previous studies derived from Western population provided a leading consensus that Gram-positive aerobes, particularly
Medical records of 745 patients with diabetic foot ulcers, who were admitted and treated at the Diabetic Wound Center of Korea University Guro Hospital between January 2011 and December 2015, were reviewed. A complete medical history was obtained at the first visit. For analysis of the demographic and clinical characteristics, 8 variables such as age, gender, smoking history, dialysis, HbA1C, wound duration, transcutaneous partial oxygen tension (TcpO2) and previous use of antibiotics were investigated (
Only intraoperative samples collected from surgical procedures were included in the study. Surgical debridement was performed to remove all non-viable tissue from the wounds. Deep tissue and/or bone specimens were obtained and immediately stored in aseptic tube for culture. The specimens were sent to microbiologic laboratory in our hospital and incubated at 35°C for 24-48 hours in Sheep blood agar plate. Furthermore, MacConkey II agar plate was used for aerobes and Chocolate agar plate for anaerobes.
Out of the 745 patients enrolled in this study, 613 patients (82.2%) had isolated causative organisms and 832 microbial isolates were identified which are presented in
Diabetic foot infection is common and complex public health problem, particularly of importance in diabetes mellitus patients [
The predominant causative microbiological organisms of DFI in Western population are Gram-positive aerobes, especially
On the other hand, recent studies have demonstrated different etiological distribution of causative organisms of DFI in different regions of the world [
Our study found that Gram-positive aerobes (57.5%) were isolated more frequently than Gram-negative aerobes (40.0%) and MRSA (13.7%) was a predominant pathogen, but the proportion of MRSA was relatively small when compared to Western population (30.1-48.8%) [
This microbiological data was analyzed for comparing to our previous data obtained from same center in 2007, which estimated microbiological transition trend of diabetic foot infection. The distribution of microbial isolates between 2007 and 2016 is reported in
On the other hand, Gram-negative aerobes (33.3% in 2007, 40.0% in 2016) and
Current clinical guidelines, according to IDSA, for the management of DFI recommend empirical antibiotics classified by the fact whether
The results of microbiologic analysis in Korean DFI patients differ from the reports from Western population. Although MRSA was the most common causative organism,
No potential conflict of interest relevant to this article was reported.
Patient demographics
Variable | Total (n = 745) |
---|---|
Age (year) | 62 ± 12.1 |
Gender | |
Male | 540 (72.5%) |
Female | 205 (27.5%) |
Smoking history | |
Yes | 245 (32.9%) |
No | 500 (67.1%) |
Dialysis | |
Yes | 176 (23.6%) |
No | 569 (76.4%) |
HbA1C (%) | 8.0 ± 1.8 |
Wound duration (week) | 19.1 ± 8.3 |
TcpO2 (mmHg) | 34.6 ± 20.7 |
Previous use of antibiotics | |
Yes | 534 (71.7%) |
No | 211 (28.3%) |
TcpO2, Transcutaneous partial oxygen tension.
Microorganisms isolated from wound
Name of isolates | Number (%) |
---|---|
Gram positive aerobes | 478 (57.5) |
|
114 (13.7) |
|
105 (12.6) |
|
104 (12.5) |
|
54 (6.5) |
|
29 (3.5) |
|
14 (1.7) |
|
8 (1.0) |
|
5 (0.6) |
Others | 45 (5.4) |
Gram negative aerobes | 333 (40.0) |
|
78 (9.4) |
|
60 (7.2) |
|
27 (3.2) |
|
25 (3.0) |
20 (2.4) | |
|
17 (2.0) |
|
13 (1.6) |
|
13 (1.6) |
|
12 (1.4) |
|
10 (1.2) |
Others | 58 (7.0) |
Fungal | 9 (1.1) |
|
7 (0.8) |
Others | 2 (0.2) |
Anaerobes | 12 (1.4) |
Total | 832 |
Comparative analysis with a previous study
Microorganism | 2007 | 2016 |
---|---|---|
Gram positive aerobes | 76.4% | 57.5% |
|
29.4% | 13.7% |
|
15.6% | 12.5% |
|
13.5% | 12.6% |
|
15.9% | 6.5% |
|
2.0% | 17.0% |
Gram negative aerobes | 33.3% | 40.0% |
|
7.8% | 9.4% |
|
7.3% | 7.2% |
|
6.9% | 3.2% |
|
4.5% | 3.0% |
|
4.3% | 2.4% |
|
2.3% | 1.6% |
Fungal | 2.0% | 1.1% |
Anaerobes | 0.0% | 1.4% |