Author/Editor		Urbančič-Rovan, Vilma
Title		Diabetic foot infections - diagnosis and treatment
Type		monografija
Place		Zagreb
Publisher		Sveučilište u Zagrebu, Medicinski fakultet
Publication year		1996
Volume		str. 93
Language		eng
Abstract		Clinical and microbiological characterics of 130 diabetic foot ulcers, treated at the Out-Patient Diabetic Foot Clinic, were studied. The majority of the observed group belonged to the group of spontaneously developed neuropathic ulcers, grade 2 by Wagner classification. The clinical course was mostly without systemic signs of infection. Leukocyte count was normal in 82.9%, while erythrocyte sedimentation rate was elevated in 82.9% of cases. Presence or absence of osteomyelitis was determined on the basis of x-rays of the affected foot. Swabs from ulcer base and from the surrounding skin were taken at the time of first, second and final visit to the clinic. 70% of the swabs yielded mixed flora, the most frequent isolates being Staphylococci (47.1 %), Streptococci (23.5%) and Gram-negative nonfermentative bacilli (19.5%). Anaerobes represented only 5.4% of the isolates from the wounds. The isolates from the surrounding skin were essentially similar. Simultaneously, tissue samples (curettage of the ulcer base) were taken and yielded similar flora as superficial swabs. In all the isolates, the susceptibility to a set of eight antibiotics was tested: ampicillin, amoxicillin + clavulanate, cefaclor, ceftazidime, ciprofloxacin, clindamycin, amikacin and metronidazole. The best results were obtained by ciprofloxacin and amoxicillin + clavulanate (respectively, 76.9% and 74.0% of susceptible strains) while metronidazole proved to be inefficient even in 31.6% of the isolated anaerobes. Antibiotic therapy had no influence on the number and sort of isolates found by the second and final visit, nor on their susceptibility to antibiotics. Accordingly, we recommend amoxicillin + clavulanate as first choice therapy of infected diabetic foot ulcers. (Abstracts truncated at 2000 characters)
Descriptors		DIABETIC FOOT WOUND INFECTION ANTIBIOTICS MICROBIAL SENSITIVITY TESTS LEUKOCYTE COUNT BACTERIA AMPUTATION