Bacterial “landscape” of purulent focus and principles of antibiotic therapy in patients with diabetic foot syndrome
DOI:
https://doi.org/10.11603/2414-4533.2018.1.8880Keywords:
diabetic foot syndrome, bacterial landscape, antibiotic susceptibility.Abstract
The aim of the work: assessment of the bacterial spectrum and the effectiveness of the appointment of antibacterial therapy in patients with diabetic foot syndrome.
Materials and Methods. The results of the treatment of 269 patients (148 (55.01 %) men and 121 (44.09 %) women) were analyzed. They were at inpatient treatment in the Surgical Department with Osteomyelitis Center on the basis of the Volyn Regional Hospital of War Veterans on the purulent-necrotic complications of SDS. All examined patients were pre-treated in surgical hospitals in the region regarding purulent-necrotic SDS processes, which was carried out empirical antibiotic therapy for up to 10 days. The neuropathic form of SDS was established in 84 (31.2 %) patients, mixed – 148 (55.01 %), ischemic – 37 (13.7 %). The prevalence of purulent necrotic process in patients with SDS, according to the classification of Wagner: I degree – 20 (7.4 %), II degree – 92 (34.2 %), III degr ee – 70 (26 %), IV degree – 65 (24.2 %), V degree – 22 (8.2 %). The complex of bacteriological studies consisted in the study of wound exudate with the identification of the microflora of purulent necrotic center and the evaluation of its sensitivity to antibiotics and cytological examination of smears-impressions from the wound surface. Identification of pathogens of the infectious process was carried out by cropping method on the appropriate nutrient medium, and sensitivity to antibiotics was determined by the disc diffusion method.
Results and Discussion. The microbial landscape of purulent-necrotic lesions in patients with diabetes mellitus is mainly polyvalent in 54.6 % of cases, and monoculture in 45.4 % of patients. The largest number of microbial associations sown from the primary purulent cell were aerobic associations – 54.6 %. Aerobic-anaerobic associations were sown in isolated cases, and sowing of anaerobic associations was not noted. The main representative of the mixed aerobic infection was Staphylococcus aureus. Often Staphylococcus aureus was sown along with the gram-positive sticks – Enterococcus faecalis, Corynebacterium xerosis and Staphilococcus epidermidis. The greatest clinical significance of the group of non-fermenting microorganisms in the aerobic association is Pseudomonas aeruginosa. The results of the study of the sensitivity of microorganisms during hospitalization indicate a high resistance of the microflora to antibiotics I-II generations of the penicillin group, cephalosporins. Antibiotics of the reserve are preparations of the group of carbapenems, oxazolidinones, glycopeptides.
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