In vitro activity of tigecycline against strains isolated from diabetic foot ulcers (original) (raw)
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Diagnostic Microbiology and Infectious Disease, 2014
A phase 3, randomized, double-blind trial was conducted in subjects with diabetic foot infections without osteomyelitis (primary study) or with osteomyelitis (substudy) to determine the efficacy and safety of parenteral (intravenous [iv]) tigecycline (150 mg once-daily) versus 1 g once-daily iv ertapenem ± vancomycin. Among 944 subjects in the primary study who received ≥1 dose of study drug, N85% had type 2 diabetes;~90% had Perfusion, Extent, Depth/tissue loss, Infection, and Sensation infection grade 2 or 3; and 20% reported prior antibiotic failure. For the clinically evaluable population at test-of-cure, 77.5% of tigecycline-and 82.5% of ertapenem ± vancomycin-treated subjects were cured. Corresponding rates for the clinical modified intent-to-treat population were 71.4% and 77.9%, respectively. Clinical cure rates in the substudy were low (b36%) for a subset of tigecycline-treated subjects with osteomyelitis. Nausea and vomiting occurred significantly more often after tigecycline treatment (P = 0.003 and P b 0.001, respectively), resulting in significantly higher discontinuation rates in the primary study (nausea P = 0.007, vomiting P b 0.001). In the primary study, tigecycline did not meet criteria for noninferiority compared with ertapenem ± vancomycin in the treatment of subjects with diabetic foot infections.
Journal of Clinical Microbiology, 2007
As part of a United States-based multicenter clinical trial, conducted from 2001 to 2004, that compared ertapenem to piperacillin-tazobactam for the treatment of moderate-to-severe diabetic foot infections (DFIs), we obtained 454 pretreatment specimens from 433 patients. After debridement, the investigators collected wound specimens, mostly by curettage or biopsy, and sent them to the R. M. Alden Research Laboratory for aerobic and anaerobic culture. Among the 427 positive cultures, 83.8% were polymicrobial, 48% grew only aerobes, 43.7% had both aerobes and anaerobes, and 1.3% had only anaerobes. Cultures yielded a total of 1,145 aerobic strains and 462 anaerobic strains, with an average of 2.7 organisms per culture (range, 1 to 8) for aerobes and 2.3 organisms per culture (range, 1 to 9) for anaerobes. The predominant aerobic organisms were oxacillin-susceptible Staphylococcus aureus (14.3%), oxacillin-resistant Staphylococcus aureus (4.4%), coagulase-negative Staphylococcus specie...
PubMed, 2017
Background: Diabetic foot being one of the frequent and disabling complications of diabetes. In view of widespread regional variation in causative organisms and antimicrobial susceptibility, the current study aimed to determine frequency of causative organisms, their antimicrobial susceptibility and associated risk factors. Methods: This descriptive cross-sectional study was conducted in 6 months' duration at dept. of Medicine; PIMS Hospital Islamabad. Type 2 Diabetes mellitus patients with diabetic foot ulcer were enrolled after informed consent. Patients already receiving antibiotics, having no growth on culture and >3 weeks' duration of ulcer were excluded. Sample from wound was sent for culture and sensitivity. Antibiotic susceptibility testing identified the susceptible and resistant strains of organisms. Results: Among 114 patients (66.67% males and 33.33% females); mean age was 55.11±11.96 years. Staphylococcus aureus was identified in 46%, E. coli in 28%, Pseudomonas in 6%, Klebsiella in 3.5% and other organisms in 17%. 92% of S. aureus was sensitive to Vancomycin and 67% to Clindamycin. Amongst E. coli, 81% showed sensitivity to Imipenem, 69% to Aminoglycosides and 31% to Quinolones. Glycaemic control was unsatisfactory in 65.8%. Peripheral vascular disease was found in 46% patients and sensory neuropathy in 94%. Conclusions: Staphylococcus aureus was the most frequent isolate amongst gram positive organisms while E. coli amongst gram-negatives. Vancomycin is suggested to be the drug of choice for gram positive and Imipenem for gram negative organisms. Appropriate antimicrobial therapy according to susceptibility patterns would reduce the morbidity and emergence of multidrug resistant organisms in diabetic foot infections.
International Journal of Pharmacy and Pharmaceutical Sciences, 2020
Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used. Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel. Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms. Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.
Microbiological Study of Diabetic Foot Infections
Indian Journal of Medical Specialities, 2011
Background: Diabetic foot infections are one of the most feared complications of diabetes. This study was undertaken to determine the common aetiological agents of diabetic foot infections and their in vitro antibiotic susceptibility. Methods: A prospective study was performed over a period of one year in a tertiary care hospital. The aerobic bacterial agents were isolated and their antibiotic susceptibility pattern was determined. Members of Enterobacteriaceae were tested for extended spectrum β-lactamase (ESBL) production by combination disc method and staphylococcal isolates were tested for susceptibility to oxacillin by screen agar method. Results: Klebsiella pneumoniae (20.5%), Pseudomonas aeruginosa (17%), Staphylococcus aureus (17%) and Escherichia coli (14.6%) were the most common aetiological agents. Polymicrobial infection was observed in 52% patients. The members of Enterobacteriaceae as well as Pseudomonas spp. and Acinetobacter spp. were found to be susceptible mainly to amikacin, piperacillin-tazobactam and imipenem. Staphylococcus aureus and Enterococcus spp. were susceptible mostly to vancomycin, with varying susceptibility to tetracycline. 56% of the isolates belonging to Enterobacteriaceae were producing ESBL and 65.5% of Staphylococcus aureus were methicillin-resistant. Conclusion: High prevalence of multi-drug resistant pathogens was observed. Amikacin, piperacillintazobactam, imipenem were active against gram-negative bacilli, while vancomycin was found to be active against gram-positive bacteria.
The Journal of Infection in Developing Countries, 2013
Introduction: In the present study, we sought to identify the bacterial organisms associated with diabetic foot infections (DFIs) and their antibiotic sensitivity profiles. Methodology: We retrospectively reviewed the records of wound cultures collected from diabetic patients with foot infections between May 2005 and July 2010. Results: We identified a total of 298 culture specimens (165 [55%] wound swab, 108 [36%] tissue samples, and 25 [9%] bone samples) from 107 patients (74 [69%] males and 33 [31%] females, mean age 62 ± 13 yr) with a DFI. Among all cultures 83.5% (223/267) were monomicrobial and 16.4% (44/267) were polymicrobial.
Current Scenario in Anti-Microbial Therapy and Emerging Treatment in Diabetic Foot Ulcer
International Journal for Research in Applied Sciences and Biotechnology, 2022
Diet-related complications such as diabetic foot ulcers are the leading cause of death for diabetics. In clinical studies, a wide variety of medications from various pharmacological families are being used to treat diabetic foot ulcers, but only a few have received regulatory approval. Diabetic foot ulcers are caused by a variety of factors, including neuropathy, peripheral artery disease, infection, gender, smoking, and age. Bacterial resistance to present medications is a problem in the treatment of diabetic foot ulcers. For diabetic foot ulcers, this study focuses on the existing treatment, the current treatment method, and potential pharmaceutical targets. Rather of relying on a single medicine to cure a diabetic foot ulcer, a combination of therapy is the best option because several factors contribute to its development. These studies show that treating diabetic foot ulcers in the absence of routine access to laboratory or radiographic testing is possible despite the various ch...
Diabetic foot infections typically begin in a wound, most often due to neuropathic ulceration. Diabetic foot infection facing unique challenge of successful treatment because of wide spread of resistant bacteria to many antibiotics. Combination antibiotic therapy could be helpful to combat these resistant bacteria. This basically depends on the microbial etiology and selection of appropriate antibiotics for combination therapy. Using manual E-test method, Minimum inhibitory concentration (MIC) was determined susceptibility to individual antibiotics. Fractional inhibitory concentration index (FICI) was used to determine synergistic effects for combined antibiotics. . Gentamicin susceptibility showed 100%, 20%, 30%, 80% and 70% of Escherichia coli, Klebsiella pneumonia, Proteus spp, Pseudomonas spp, and Staphylococcus aureus, were sensitive, respectively. Ciprofloxacine showed 80%, 30%, 60%, 40% and 90 % resistant to Escherichia coli, Klebsiella pneumonia, Proteus spp, Pseudomonas spp, and Staphylococcus aureus, respectively. Ceftriaxone showed 50%, 40% 60%, 10%, and 70% resistant result against Escherichia coli, Klebsiella pneumonia, Proteus spp, Pseudomonas spp, and Staporhylococcus aureus, respectively. Fractional inhibitory concentration index (FICI) recorded and synergistic effects were determined. Knowledge on the antibiotic synergy pattern of the iso?lates will be helpful in determining the drugs for the empirical treatment of diabetic foot infections.
Journal of Ayub Medical College, Abbottabad : JAMC
Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. This descriptive cross-sectional study was performed in the Departments of Medicine and Surgery, Khyber Teaching Hospital, Peshawar from April, 2011 to February, 2012. Specimens collected from ulcers of 131 patients were inoculated on Blood Agar and MacConkey Agar, and antibiotic sensitivity was tested using standard disc diffusion method. Out of 131, specimens from 120 patients yielded 176 bacteria. Sixty-six patients had monomicrobial infection while polymicrobial growth was obtained in 54 patients. Overall, Staphylococcus aureus (38.6%) was the most common isolate followed by Pseudomonas aeruginosa (27.3%). Staphylococcus aureus was most often sensitive to Moxifloxacin, Imi...