Microbiological spectrum of clinically infected foot ulcers

Published Date: 19th July 2016

Publication Authors: Ball R

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Aims

Infection is common in diabetes foot ulcers and early judicious use of antibiotics is important to reduce complications. The choice of initial antibiotic should be based on local microbiological flora. The aim of this study was to determine the microbiological spectrum of clinically infected foot ulcers in patients with diabetes. 

Methods

Consecutively reviewed patients with new foot ulcers attending a multidisciplinary diabetic foot clinic between June 2014 and June 2015 were included. Swabs from the foot ulcers were done if there was clinical suspicion of infection and antibiotics were prescribed empirically. Data collected included baseline characteristics, culture and sensitivity results from wound swabs and the antibiotics used. 

Results

134 patients (69%, male) with diabetes (89%, Type 2 diabetes) presented with new foot ulceration. 57% (76/134) of the patients had swabs done on the first clinic visit. 38% (29/76) of the swabs revealed one organism and 29% (22/76) two organisms. 33% of the swabs grew Staphylococcus aureus (two patients with MRSA), 13% grew Streptococcus and 25% revealed Enterobacteriaceae species (Escherichia coli, Pseudomonas, Klebsiella). 20% swabs revealed normal flora. 51% (69/134) patients were treated with antibiotics. The common initial antibiotics used included flucloxacillin 43% (30/69), cephalosporins 20% (14/69) and clindamycin 13% (9/69). 

Conclusions

Gram positive organisms (Staphyloccous aureus and Streptococcus) are the commonest organisms causing infection in diabetes foot ulcers. Empirical treatment with beta-lactam antibiotics (before results of culture and sensitivity are available) is appropriate.

Ball, R; Cheung, F; Deacon, L; Srinivas-Shankar, U. (2016). Microbiological spectrum of clinically infected foot ulcers in patients with diabetes​ . Diabetic Medicine. 33 (Suppl S1), 53.

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