Zemlyanoj A.B.1, Zelenina T.A.2, Saluhov V.V.2
1 Pirogov National Medical and Surgical Center, Moscow
2 S.M. Kirov Military Medical Academy, Saint Petersburg
Aim of the study: to compare the prevalence and specific characteristics of the severe diabetic foot infection pathogens during the inpatient and outpatient stages of treatment.
Materials and methods. We included 62 type 2 diabetic inpatients (group 1) (38 male and 24 female) with severe foot infection in to the study. 102 diabetic foot outpatients (group 2) (56 male and 46 female) with postoperative wounds, who had been operated on and discharged from the hospital, were included in to the study too.
The complex of clinical and laboratory-instrumental examinations and treatment of the postoperative wounds according to the international standards were performed. 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. Severe infection connected with polymicrobe pathogens in both groups of patients. However, the prevalence of Gram-positive and Gram-negative bacilli was different. The most frequently isolated pathogens were Gram-positive bacteria in the wound samples of group 1 of patients with acute infection obtained after surgery interventions immediately. In the wound cultures of group 1 on 14 day of hospitalization and group 2 the prevalence of Gram-positive and Gram-negative bacilli was the same. The role of Enterobacteriaceae increased with duration of infection. The prevalence of multidrug resistant Enterobacteriaceae makes this group of microorganisms as important as Staphylococcaceae in the complicated course of the infectious process. It should be noted that there is still a high total frequency of isolation of non-fermenting Gram-negative bacilli among Gram-negative pathogens in complicated diabetic foot infection both at the inpatient and outpatient stages of treatment.
Conclusion. The microbial load characterized by the presence of Gram-positive and Gram-negative pathogens after surgical debridement of acute infection at the inpatient stage of treatment. However, Grame-positive microorganisms predominated significantly (Staphylococcus aureus). The great finding of the study is the identification of a parallel of the same prevalence of Gram-positive and Gram-negative pathogens in a prolonged infection at the inpatient and outpatient stages of treatment.
Polyvalent microbial spectrum of pathogens significantly reduces the effectiveness of treatment.
Keywords: diabetes mellitus, diabetic foot syndrome, multidrug resistant microorganisms, postoperative wounds healing.
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