A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda

Donna Kaye Bennett; Tamar Nasqidashvili; Joseph Saunders; Lavern Swaby; Clyde Wilson

doi:doi:10.11648/j.ijde.20210602.14

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A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda

Donna Kaye Bennett, Tamar Nasqidashvili, Joseph Saunders, Lavern Swaby, Clyde Wilson

Published in International Journal of Diabetes and Endocrinology (Volume 6, Issue 2)

Received: 29 March 2021 Accepted: 22 April 2021 Published: 30 April 2021

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Abstract

There is a high prevalence of type 2 diabetes mellitus in Bermuda. It has been well established that a significant number of patients with diabetes mellitus will develop a diabetic foot infection (DFI), which is associated with increased morbidity and mortality. The objectives of this study were to determine the microbiological and antimicrobial susceptibility profile in DFIs and to investigate whether methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen as well as playing a pivotal role in amputations. A retrospective study was carried out on 96 patients diagnosed with DFI. Demographic data, types of cultures, antimicrobial susceptibility profile and antimicrobial management were collected from medical records. Ninety six patients were investigated and Staphylococcus aureus was the most common organism isolated, followed by Pseudomonas aeruginosa, Group B Streptococcus and Proteus mirabilis. In addition, MRSA organisms were isolated at a low frequency. The organisms isolated showed susceptibility to commonly used antimicrobial agents such as amoxicillin/clavulante, clindamycin, cefazolin, ampicillin/sulbactam, tetracycline, ceftriaxone, trimethoprim-sulfamethoxazole and piperacillin-tazobactam. There was an association between peripheral vascular disease (PVD) and diabetes related amputations. In conclusion, Staphylococcus aureus is a common organism in DFI and the findings of the study does not support empirical MRSA antimicrobial therapy for the management of DFI. There was no evidence to suggest that there is an association between MRSA and diabetes related amputations.

Published in	International Journal of Diabetes and Endocrinology (Volume 6, Issue 2)
DOI	10.11648/j.ijde.20210602.14
Page(s)	76-79
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Diabetes Foot Infection, Amputation, Staphylococcus aureus, Methicillin Resistant Staphylococcus aureus

References

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[2]	Guariguata I, Whitting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014; 103: 137-149.
[3]	Parris D, The alarming increase of diabetes in Bermuda. West Indian Med J 2014; 63: 685.
[4]	Dialysis in Bermuda, Bermuda Health Council. 2018. http://bhec.bm/wp-content/uploads/2018/041/issue-brief-dialysis-v1-20180416.
[5]	Kwon KT, Armstrong DG. Microbiology and antimicrobial therapy for diabetic foot infections. Infect Chemother. 2018; 50: 11.
[6]	Lavery LA, Fontaine JL, Bhavan K, Kim PJ, Williams JR, Hunt NA. Risk factors for methicillin resistant Staphylococcus aureus in diabetic foot infections. Diabet Foot Ankle 2014; 5: 23575.
[7]	Eleftheriadou I, Tentolouris N, Argiana V, Jude E, Boulton AJ. Methicillin resistant Staphylococcus aureus in diabetic foot infections. Drugs 2010; 70: 1785-97.
[8]	Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019; 56: 907-21.
[9]	Shankar E, Mohan V, Premalatha R, Srinivasan S, Usha A. Bacterial aetiology of diabetic foot infections in South India. Eur J Int Med 2005; 16: 567-70.
[10]	Consensus Development Conference on diabetic wound care. Diabetes Care. 1999; 22: 1354-60.
[11]	Lipsky BA, Berendt AR, Comia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012; 54: 1679-84.
[12]	Mutonga DM, Mureithi MW, Ngugi NN, Otieno FCF. Bacterial isolation and antibiotic susceptibility from diabetic foot ulcers in Kenya using microbiological tests and comparison with RT-PCR in detection of S. aureus and MRSA. BMC Res Notes 2019; 12: 244 Doi.org/10.1186/s13104-019-4278-0.
[13]	Reveles KR, Duhon BM, Moore RJ, Hand EO, Howell CK. Epidemiology of methicillin –resistant Staphylococcus aureus diabetic foot infections in a large academic hospital: Implications for antimicrobial stewardship. PLOS ONE. 2016; 11: 11 doi: 10.1371/journal.pone.0161658.
[14]	Dang CN, Prasad YDM, Boulton AJM, Jude EB. Methicillin resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabet Med. 2003; 20: 159-161.
[15]	Richard JL, Sotto A, Jourdan N et al. Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers. Diabetes Metab. 2008; 34: 363-369.
[16]	Haleem A, Schultz JS, Heilmann KP et al. Concordance of nasal and diabetic foot ulcer Staphylococcal colonization. Diagn Microbiol Infect Dis. 2014; 79: 85-89.
[17]	Jeffcoate WJ, Margolis DJ. Incidence of major amputation for diabetes in Scotland sets a target for us all. Diabetes Care. 2012; 35: 2419-20.
[18]	Kennon B, Leese GP, Cochrane L, Colhous H, Wild S, Stang D et al. Reduced incidence of lower extremity amputations in people with diabetes in Scotland: A nationwide study. Diabetes Care. 2012; 35: 2588-90.

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APA Style

Donna Kaye Bennett, Tamar Nasqidashvili, Joseph Saunders, Lavern Swaby, Clyde Wilson. (2021). A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. International Journal of Diabetes and Endocrinology, 6(2), 76-79. https://doi.org/10.11648/j.ijde.20210602.14

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ACS Style

Donna Kaye Bennett; Tamar Nasqidashvili; Joseph Saunders; Lavern Swaby; Clyde Wilson. A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. Int. J. Diabetes Endocrinol. 2021, 6(2), 76-79. doi: 10.11648/j.ijde.20210602.14

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AMA Style

Donna Kaye Bennett, Tamar Nasqidashvili, Joseph Saunders, Lavern Swaby, Clyde Wilson. A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. Int J Diabetes Endocrinol. 2021;6(2):76-79. doi: 10.11648/j.ijde.20210602.14

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@article{10.11648/j.ijde.20210602.14,
  author = {Donna Kaye Bennett and Tamar Nasqidashvili and Joseph Saunders and Lavern Swaby and Clyde Wilson},
  title = {A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {6},
  number = {2},
  pages = {76-79},
  doi = {10.11648/j.ijde.20210602.14},
  url = {https://doi.org/10.11648/j.ijde.20210602.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20210602.14},
  abstract = {There is a high prevalence of type 2 diabetes mellitus in Bermuda. It has been well established that a significant number of patients with diabetes mellitus will develop a diabetic foot infection (DFI), which is associated with increased morbidity and mortality. The objectives of this study were to determine the microbiological and antimicrobial susceptibility profile in DFIs and to investigate whether methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen as well as playing a pivotal role in amputations. A retrospective study was carried out on 96 patients diagnosed with DFI. Demographic data, types of cultures, antimicrobial susceptibility profile and antimicrobial management were collected from medical records. Ninety six patients were investigated and Staphylococcus aureus was the most common organism isolated, followed by Pseudomonas aeruginosa, Group B Streptococcus and Proteus mirabilis. In addition, MRSA organisms were isolated at a low frequency. The organisms isolated showed susceptibility to commonly used antimicrobial agents such as amoxicillin/clavulante, clindamycin, cefazolin, ampicillin/sulbactam, tetracycline, ceftriaxone, trimethoprim-sulfamethoxazole and piperacillin-tazobactam. There was an association between peripheral vascular disease (PVD) and diabetes related amputations. In conclusion, Staphylococcus aureus is a common organism in DFI and the findings of the study does not support empirical MRSA antimicrobial therapy for the management of DFI. There was no evidence to suggest that there is an association between MRSA and diabetes related amputations.},
 year = {2021}
}

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TY  - JOUR
T1  - A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda
AU  - Donna Kaye Bennett
AU  - Tamar Nasqidashvili
AU  - Joseph Saunders
AU  - Lavern Swaby
AU  - Clyde Wilson
Y1  - 2021/04/30
PY  - 2021
N1  - https://doi.org/10.11648/j.ijde.20210602.14
DO  - 10.11648/j.ijde.20210602.14
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 76
EP  - 79
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20210602.14
AB  - There is a high prevalence of type 2 diabetes mellitus in Bermuda. It has been well established that a significant number of patients with diabetes mellitus will develop a diabetic foot infection (DFI), which is associated with increased morbidity and mortality. The objectives of this study were to determine the microbiological and antimicrobial susceptibility profile in DFIs and to investigate whether methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen as well as playing a pivotal role in amputations. A retrospective study was carried out on 96 patients diagnosed with DFI. Demographic data, types of cultures, antimicrobial susceptibility profile and antimicrobial management were collected from medical records. Ninety six patients were investigated and Staphylococcus aureus was the most common organism isolated, followed by Pseudomonas aeruginosa, Group B Streptococcus and Proteus mirabilis. In addition, MRSA organisms were isolated at a low frequency. The organisms isolated showed susceptibility to commonly used antimicrobial agents such as amoxicillin/clavulante, clindamycin, cefazolin, ampicillin/sulbactam, tetracycline, ceftriaxone, trimethoprim-sulfamethoxazole and piperacillin-tazobactam. There was an association between peripheral vascular disease (PVD) and diabetes related amputations. In conclusion, Staphylococcus aureus is a common organism in DFI and the findings of the study does not support empirical MRSA antimicrobial therapy for the management of DFI. There was no evidence to suggest that there is an association between MRSA and diabetes related amputations.
VL  - 6
IS  - 2
ER  -

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Author Information

Donna Kaye Bennett

Department of Medicine, King Edward VII Memorial Hospital, Hamilton, Bermuda
Tamar Nasqidashvili

Department of Medicine, King Edward VII Memorial Hospital, Hamilton, Bermuda
Joseph Saunders

Department of Medicine, King Edward VII Memorial Hospital, Hamilton, Bermuda
Lavern Swaby

Departments of Pathology and Microbiology, King Edward VII Memorial Hospital, Hamilton, Bermuda
Clyde Wilson

Departments of Pathology and Microbiology, King Edward VII Memorial Hospital, Hamilton, Bermuda

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APA Style

Donna Kaye Bennett, Tamar Nasqidashvili, Joseph Saunders, Lavern Swaby, Clyde Wilson. (2021). A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. International Journal of Diabetes and Endocrinology, 6(2), 76-79. https://doi.org/10.11648/j.ijde.20210602.14

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ACS Style

Donna Kaye Bennett; Tamar Nasqidashvili; Joseph Saunders; Lavern Swaby; Clyde Wilson. A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. Int. J. Diabetes Endocrinol. 2021, 6(2), 76-79. doi: 10.11648/j.ijde.20210602.14

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AMA Style

Donna Kaye Bennett, Tamar Nasqidashvili, Joseph Saunders, Lavern Swaby, Clyde Wilson. A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda. Int J Diabetes Endocrinol. 2021;6(2):76-79. doi: 10.11648/j.ijde.20210602.14

Copy | Download

@article{10.11648/j.ijde.20210602.14,
  author = {Donna Kaye Bennett and Tamar Nasqidashvili and Joseph Saunders and Lavern Swaby and Clyde Wilson},
  title = {A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {6},
  number = {2},
  pages = {76-79},
  doi = {10.11648/j.ijde.20210602.14},
  url = {https://doi.org/10.11648/j.ijde.20210602.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20210602.14},
  abstract = {There is a high prevalence of type 2 diabetes mellitus in Bermuda. It has been well established that a significant number of patients with diabetes mellitus will develop a diabetic foot infection (DFI), which is associated with increased morbidity and mortality. The objectives of this study were to determine the microbiological and antimicrobial susceptibility profile in DFIs and to investigate whether methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen as well as playing a pivotal role in amputations. A retrospective study was carried out on 96 patients diagnosed with DFI. Demographic data, types of cultures, antimicrobial susceptibility profile and antimicrobial management were collected from medical records. Ninety six patients were investigated and Staphylococcus aureus was the most common organism isolated, followed by Pseudomonas aeruginosa, Group B Streptococcus and Proteus mirabilis. In addition, MRSA organisms were isolated at a low frequency. The organisms isolated showed susceptibility to commonly used antimicrobial agents such as amoxicillin/clavulante, clindamycin, cefazolin, ampicillin/sulbactam, tetracycline, ceftriaxone, trimethoprim-sulfamethoxazole and piperacillin-tazobactam. There was an association between peripheral vascular disease (PVD) and diabetes related amputations. In conclusion, Staphylococcus aureus is a common organism in DFI and the findings of the study does not support empirical MRSA antimicrobial therapy for the management of DFI. There was no evidence to suggest that there is an association between MRSA and diabetes related amputations.},
 year = {2021}
}

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TY  - JOUR
T1  - A Retrospective Study of the Microbiology of Diabetic Foot Infections at a Community Hospital in Bermuda
AU  - Donna Kaye Bennett
AU  - Tamar Nasqidashvili
AU  - Joseph Saunders
AU  - Lavern Swaby
AU  - Clyde Wilson
Y1  - 2021/04/30
PY  - 2021
N1  - https://doi.org/10.11648/j.ijde.20210602.14
DO  - 10.11648/j.ijde.20210602.14
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 76
EP  - 79
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20210602.14
AB  - There is a high prevalence of type 2 diabetes mellitus in Bermuda. It has been well established that a significant number of patients with diabetes mellitus will develop a diabetic foot infection (DFI), which is associated with increased morbidity and mortality. The objectives of this study were to determine the microbiological and antimicrobial susceptibility profile in DFIs and to investigate whether methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen as well as playing a pivotal role in amputations. A retrospective study was carried out on 96 patients diagnosed with DFI. Demographic data, types of cultures, antimicrobial susceptibility profile and antimicrobial management were collected from medical records. Ninety six patients were investigated and Staphylococcus aureus was the most common organism isolated, followed by Pseudomonas aeruginosa, Group B Streptococcus and Proteus mirabilis. In addition, MRSA organisms were isolated at a low frequency. The organisms isolated showed susceptibility to commonly used antimicrobial agents such as amoxicillin/clavulante, clindamycin, cefazolin, ampicillin/sulbactam, tetracycline, ceftriaxone, trimethoprim-sulfamethoxazole and piperacillin-tazobactam. There was an association between peripheral vascular disease (PVD) and diabetes related amputations. In conclusion, Staphylococcus aureus is a common organism in DFI and the findings of the study does not support empirical MRSA antimicrobial therapy for the management of DFI. There was no evidence to suggest that there is an association between MRSA and diabetes related amputations.
VL  - 6
IS  - 2
ER  -

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