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MRSA in diabetic foot ulcers

Discussion in 'Diabetic Foot & Wound Management' started by Admin2, Nov 1, 2005.

  1. Admin2

    Admin2 Administrator Staff Member


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    Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers
    Clinical Microbiology & Infection- October 2005
     
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    Mrsa

    Prevalence of methicillin-resistant Staphylococcus aureus in infected and uninfected diabetic foot ulcers.
    Clin Microbiol Infect. 2006 Feb;12(2):186-9
     
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    Methicillin-resistant Staphyloccocus aureus (MRSA)

    Methicillin-resistant Staphyloccocus aureus (MRSA) isolation from diabetic foot ulcers correlates with nasal MRSA carriage.
    Diabetes Res Clin Pract. 2006 Sep 8;
    Stanaway S, Johnson D, Moulik P, Gill G
     
  4. John Spina

    John Spina Active Member

    What is scary is that this is now becomig community based.I had at least 1 patient who,of course is diabetic with multiple abcesses.I drained these and the culture was MRSA.He was outpatient,so that was something I found curious.
     
  5. Cameron

    Cameron Well-Known Member

    I would certainly concur with you there, John. The number of clients attending the outpatient unit, I work at with report MRSA has increased significantly recently .

    I noticed the advice given by the Infection Control nurse to a client recently diagnosed with MRSA infection indicated clearly the nasal passages as a potential source of cross infection to the feet. The client was given instruction on the importance of swabbing the nose with a prescribed antimicrobal solution.

    Cameron
     
  6. John Spina

    John Spina Active Member

    Cameron,it shocked me to see an outpatient with MRSA.I think it is because(and I may be guilty of this as well) doctors overprescribe antibiotics and the bugs are developing a resistance to these meds.
     
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    Mrsa

    Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms.
    J Infect. 2006 Sep 30;
    Kandemir O, Akbay E, Sahin E, Milcan A, Gen R
     
  8. The increasing incidence of MRSA is certainly worrying. In our high risk diabetes clinic we would probably see around 15-20 patients who currently have MRSA colinising in there wounds. I guess the difficult situation is when a wound comes in and is clinically infected, a Dr is called and a swab taken. Should the swab results be obtained to detemine the sensitivity of the organism?

    I know Dr's often have a fair idea of the infecting organism but are these some things that may need to be put it place to prevent the increase in MRSA.
     
  9. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Justin, this question highlights the difference between *empirical* and *targeted/directed* antibiotic therapy.

    Empirical therapy makes an assumption about the *most likely* causative organism, and directs treatment towards that pathogen. A bit like using a 4 degree post on every foot pain that walks through the door - some will get better, most probably won't. If anything, this increases the prevalence of MRSA in the community.

    Targeted/directed therapy relies on identifiying, through culture and sensitivity, the most appropriate antibioitic regieme. This is the standard you should work towards.

    In reality, the practice of empiral dosing whilst awaiting the outcomes of C&S is the norm.

    LL
     
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    Mrsa

    This paper was presented at the American Diabetes Association 66th Annual Scientific Sessions - June 9-13, 2006, Washington, D.C.:
    MRSA Isolation from Diabetic Foot Ulcers -Does It Affect Healing and Is the Problem Getting Worse?
    FRAN L. GAME, WILLIAM J. JEFFCOATE.
     
  11. HJM41

    HJM41 Member

    When i find a wound with mrsa or any organism I always wonder why i took the culture to begin with and then if i should treat with local meds or go the vanco zyvox route. I have had good results on wounds that appear clean with local treatment and get negative cultures within a week .
     
  12. John Spina

    John Spina Active Member

    I agree with Henry's post.Simple I and D does eradicate the infection in most if not all cases and hence the healing is quick and you may not even need antibiotics.I put the patients on them-a broad spectrum such as keflex works well here-and within a week or so,they are usually good to go.
     
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    Emergence of monomicrobial methicillin-resistant Staphylococcus aureus infections in diabetic foot osteomyelitis (retrospective study of 48 cases)
    Presse Med. 2007 Feb 26;
    Couret G, Desbiez F, Thieblot P, Tauveron I, Bonnet R, Beytout J, Laurichesse H, Lesens O
     
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    Epidemiology and prevalence of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in patients with diabetic foot ulcers: Focus on the differences between species isolated from individuals with ischemic vs. neuropathic foot ulcers.
    Galkowska H, Podbielska A, Olszewski WL, Stelmach E, Luczak M, Rosinski G, Karnafel W.
    Diabetes Res Clin Pract. 2009 Mar 5. [Epub ahead of print]
     
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    Are diabetic foot ulcers complicated by MRSA osteomyelitis associated with worse prognosis? Outcomes of a surgical series.
    Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero Y, Hernández-Herrero MJ, García-Morales E, Cabrera-Galván JJ, Beneit-Montesinos JV.
    Diabet Med. 2009 May;26(5):552-5.
     
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    MRSA and diabetic foot wounds: contaminating or infecting organisms?
    Bowling FL, Jude EB, Boulton AJ.
    Curr Diab Rep. 2009 Dec;9(6):440-4.
     
  17. LER

    LER Active Member

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    Methicillin-resistant Staphylococcus aureus in Diabetic Foot Ulcers in a Chinese Care Hospital: Risk Factors for Infection and Prevalence.
    Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q.
    J Med Microbiol. 2010 Jul 1. [Epub ahead of print]
     
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    Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infections.
    Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ.
    Drugs. 2010 Oct 1;70(14):1785-1797. doi: 10.2165/11538070-000000000-00000.
     
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    Cost avoidance using linezolid for methicillin-resistant Staphylococcus aureus infections in a specialist diabetes foot clinic.
    Young MJ, Hodges G, McCardle JE.
    J Antimicrob Chemother. 2012 Aug 17.
     
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    Relationship and susceptibility profile of Staphylococcus aureus infection diabetic foot ulcers with Staphylococcus aureus nasal carriage.
    Taha AB.
    Foot (Edinb). 2012 Dec 19
     
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    Co-Therapy Using Lytic Bacteriophage and Linezolid: Effective Treatment in Eliminating Methicillin Resistant Staphylococcus aureus (MRSA) from Diabetic Foot Infections.
    Chhibber S, Kaur T, Sandeep Kaur.
    PLoS One. 2013;8(2):e56022.
     
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    Risk Factors and Gene Type for Infections of MRSA in Diabetic Foot Patients in Tianjin, China
    Shu-Hong Feng, et al
    International Journal of Lower Extremity Wounds June 2013 vol. 12 no. 2 106-112
     
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    Reversion of Methicillin-Resistant Staphylococcus aureus Skin Infections to Methicillin-Susceptible Isolates
    Anisha B. Patel; Emma Hill; Eric L. Simpson; Jon M. Hanifin
    JAMA Dermatol. 2013;():-. doi:10.1001/jamadermatol.2013.4909.
     
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    Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot.
    Lee MJ, Lee KY, Kim SS, Kim CH, Wang L, Kim HJ, Kim KW.
    J Korean Foot Ankle Soc. 2013 Sep;17(3):209-214.
     
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    Press Release
    Study examines effect of use of gloves and gowns for all patient contact in ICUs on MRSA or VRE
     
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    Press Release:
    Universal gown and glove use by health-care workers in ICU reduces MRSA 40 percent
    20-site study finds increase in handwashing frequency and no harm to patients; another common antibiotic-resistant bacteria, VRE, not reduced
     
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    Press Release:
    Northeastern researchers have discovered a new treatment to cure MRSA infection
     
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    Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) in non surgical wounds.
    Gurusamy KS, Koti R, Toon CD, Wilson P, Davidson BR.
    Cochrane Database Syst Rev. 2013 Nov 18
     
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    Clinical Characteristics and Risk Factors of Diabetic Foot Ulcer With Multidrug-Resistant Organism Infection.
    Ji X, Jin P, Chu Y, Feng S, Wang P.
    Int J Low Extrem Wounds. 2014 Feb 10
     
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    Genome Sequences of Four Clinical Staphylococcus aureus Strains with Diverse Drug Resistance Profiles Isolated from Diabetic Foot Ulcers
    Thokur Sreepathy Muralia et al
    Genome Announc. March/April 2014 vol. 2 no. 2 e00204-14

     
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    Daptomycin for Methicillin-Resistant Staphylococcus aureus Diabetic Foot Infections
    Warren S. Joseph , DPM, Thomas Quast , MD, Alberto Cogo , MD, Monica G. Crompton , PharmD, Min Jung Yoon , MPH, Kenneth C. Lamp , PharmD, Darren Culshaw , PharmD, and Ricardo L. Chaves , MD, PhD
    Journal of the American Podiatric Medical Association: March 2014, Vol. 104, No. 2, pp. 159-168.
     
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    Risk factors for methicillin-resistant Staphylococcus aureus in diabetic foot infections.
    Lavery LA, Fontaine JL, Bhavan K, Kim PJ, Williams JR, Hunt NA.
    Diabet Foot Ankle. 2014 Apr 10;5.
     
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    Prevalence of Multiple Antibiotic Resistant Infections in Diabetic versus Nondiabetic Wounds.
    Trivedi U, Parameswaran S, Armstrong A, Burgueno-Vega D, Griswold J, Dissanaike S, Rumbaugh KP.
    J Pathog. 2014;2014:173053.
     
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    Do Diabetic Foot Infections With Methicillin-Resistant Staphylococcus aureus Differ From Those With Other Pathogens?
    Besa Zenelaj et al
    International Journal of Lower Extremity Wounds October 5, 2014
     
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    Infections of Diabetic Foot Ulcers With Methicillin-Resistant Staphylococcus aureus
    Estrella Cervantes-García et al
    International Journal of Lower Extremity Wounds January 8, 2015
     
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    Clinical and haematological predictors of acute hematogenous Methicillin Resistant Staphylococcus aureus (MRSA) osteomyelitis & septic arthritis
    Rahul Agrawal, Deep Sharma, Pooja Dhiman, Dilip Kumar Patro
    Journal of Orthopaedics ; Article in Press
     
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    Characterization of multidrug-resistant diabetic foot ulcer enterococci.
    Semedo-Lemsaddek T, Mottola C, Alves-Barroco C, Cavaco-Silva P, Tavares L, Oliveira M
    Enferm Infecc Microbiol Clin. 2015 Feb 19
     
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    Guillamet CV, Kollef MH.
    Curr Opin Infect Dis. 2016 Jan 15
     
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    A whole health economy approach to reducing MRSA bacteraemia incidence in diabetic foot ulcer patients
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