Parallels of diabetic foot infections antibiotic resistance at inpatient and outpatient stages of treatment

Introduction. The risk of infectious complications in patients with diabetic foot syndrome (DFS) is 25.2 to 58%, the risk of hospitalization among the patients with complications of DFI is 56 times, and the risk of amputation is 155 times higher than non-diabetics. Detection of the etiologic agent has a crucial role in effective treatment, prevention of dissemination of the infection, and avoiding amputation.

Aim of the study: to analyze the specific characteristics of the severe diabetic foot infection and antibiotic resistance of the pathogens during the inpatient and outpatient stages of treatment.

Materials and methods. We included 62 type 2 diabetic inpatients (38 male and 24 female, group 1) with severe foot infection in to the study. 102 diabetic foot outpatients (56 male and 46 female, group 2) with postoperative wounds were included after discharged from the hospital. Cultures were obtained after surgery interventions immediately and on 14 days of hospitalization in group 1 of patients and in group 2 of patients with clinical signs of infection. Microbe species and resistant of pathogens to antibiotic were assessed.

Results. There were prevalence of multidrug resistant Staphilococcus aureus (MRSA), Enterobacterales and Acinetobacter baumannii both outpatient and inpatient stages of diabetic foot infections treatment. The multidrug resistant pathogens were associated with ineffective empiric antibiotic therapy, delay of wound healing and amputations. The presence of multidrug resistant pathogens should be expected in cases of wound size more than 18 sm², history of diabetic foot amputations, chronic osteomyelitis and time before wound professional care more than 14 weeks.

Conclusion. The multidrug resistant pathogens were the main risk factor of amputations in diabetic foot inpatients with severe infections. At the outpatient stage of treatment multidrug resistant pathogens along with chronic osteomyelitis lead to delay of wound healing and new cases of foot amputations in diabetic patients. 

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