The approaches to the choice of starting antibacterial agents in patients with diabetic foot syndrome undergoing inpatient treatment in St. Joseph Belgorod Regional Clinical Hospital

Abstract

Background and Objective: Persistent ulcers in patients with diabetic foot syndrome in 85% of cases lead to amputation because of secondary infection and growing gangrene that significantly worsen the prognosis. Methods: It was found, that in patients with diabetic foot infection dominated Gram-positive microorganisms (62.7%). It was detected Staphylococcus aureus (23.4%), Staphylococcus spp. (25.8%), and Enterococcus spp. (14.5%). Among the Gram-negative aerobes, Pseudomonas spp. was the more frequently isolate (14.5%). Enterobacteriaceae were detected in 18.5% cases. Candida spp. was isolated in 1.6% cases. It was dominated Gram-positive cocci in Wagner Grade I-III: S. aureus was isolated in 36.34% - 23.89% cases; Staphylococcus spp. was detected in 22.22% - 28.94% cases; Enterococcus spp. was determined at 8.33% - 18.5% cases in Wagner Grade IV and V was found increased amount Gram-negative rods from 39.18% tо 63.63%, respectively. It was presented Enterobacteriaceae spp. and Pseudomonas aeruginosa. Results: The analysis of antibiotic susceptibility of Gram-positive strains recorded increase of resistance to oxacillin in isolated strains of Staphylococcus spp. (S. aureus and coagulase-negative staphylococci) from 25% to 100% in Wagner Grade I and V, respectively. In Wagner Grade IV and V was detected Enterobacteriaceae producing extended spectrum beta lactamase in 75% (Escherichia coli, Klebsiella pneumoniae, and Citrobacter diversus) and 83.3% (E. coli, Proteus vulgaris, and K. pneumonia) cases, respectively. Studying the P. aeruginosa sensitivity to antibiotics in Wagner Grade IV and V was registered decrease susceptibility to ceftazidime in 36.36% and 0%, meropenem in 85.7% and 50%, levofloxacin in 68.18% and 50%, ciprofloxacin in 54.54% and 50%, and amikacin in 42.7% and 33.3%, respectively. Conclusion: It is discussed the approaches to the choice of starting antibacterial agents depend on the structure of pathogens and their sensitivity to antibiotics in patients with diabetic foot ulcers with different Wagner grades in patients with diabetic foot syndrome undergoing inpatient treatment in St. Joseph Belgorod Regional Clinical Hospital.