Correlation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot

Transcription

1 Correlation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot Department of Orthopaedic Surgery, College of Medicine, Dong-A university, Busan, Korea Myoung Jin Lee M.D., Ki Woong Kim, M.D.

2 <Correlation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot> < Myoung Jin Lee M.D., Ki Woong Kim, M.D.> My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Purpose To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation

4 Materials and Methods Jan ~ Jan patients, 131 feet - Male : 81 / Female : 48 - Rt. foot : 72 / Lt. foot : 59 Mean Age : 68.3 years (51~89) Mean F/U : 31 months (12~64) Mean duration of diabetes : 14.1 years (1~28) Mean preop. BST : 212 mg/dl (105~514) Mean preop. HbA1c : 8.65% (5.6~15.9) Medication - Oral : 74 patients, - Insulin inject : 34 patients - Combination : 21 patients

5 Materials and Methods Severe systemic disease was excluded - sepsis, malignant neoplasm, severe heart failure, severe grade of chronic kidney disease & liver cirrhosis Angio CT - for evaluation of lower limb vascularity - 12 patients excluded d/t arterial stenosis or occlusion Tissue specimens or material obtained from the bottom of a washed wound Abscess aspiration Gram staining and Culture for microbial sensitivity

6 Materials and Methods In culture, MSSA : 34 MRSA : 24 Enterobacter cloacae : 12 Pseudomonas aeruginosa : 10 Enterococcus faecalis : 12 Mixed infection : 14 Escherichia coli (3) Acinetobacter baumanni (2) Serratia marcescens (1) Klebsiella pneumonia (2) Proteus vulgaris (1) Enterobacter aerogenes (2) Other microorganisms : 8

7 Materials and Methods Mixed infection : 14 cases Acinetobacter baumannii + Enterococcus faecalis : 3cases Acinetobacter baumannii + Proteus mirabilis : 2 cases Acinetobacter baumannii + Serratia marcescens : 2 cases Staphylococcus aureus + Klebsiella pneumoniae : 2cases Acinetobacter baumannii + Streptococcus pneumoniae : 2 cases MRSA + Enterobacter cloacae : 1case Staphylococcus aureus + Enterobacter cloacae : 1case Escherichia coli + Enterobacter cloacae : 1case

8 Results Amputation level Complication Additional amputation Duration of treatment Patient s satisfaction Death More major amputation in mixed infection group Microorganism Major (n) Minor (n) Total P-value MSSA > 0.05 MRSA > 0.05 Mixed infection < 0.05 Enterobacter cloacae > 0.05 Pseudomonas aeruginosa > 0.05 Enterococcus faecalis > 0.05 No growth > 0.05

9 Results Amputation level Complication Additional amputation Duration of treatment Patient s satisfaction Death More complication in mixed infection group Microorganism Necrosis /Reinfection (n) Total P-value MSSA 2/5 34 > 0.05 MRSA 4/8 24 > 0.05 Mixed infection 4/6 14 < 0.05 Enterobacter cloacae 0/1 12 > 0.05 Pseudomonas aeruginosa 0/2 10 > 0.05 Enterococcus faecalis 0/1 8 > 0.05 No growth 0/1 17 > 0.05

10 Results Amputation level Complication Additional amputation Duration of treatment Patient s satisfaction Death Longer duration of treatment in mixed infection group Microorganism Duration of treatment (days) Total P-value MSSA > 0.05 MRSA > 0.05 Mixed infection < 0.05 Enterobacter cloacae > 0.05 Pseudomonas aeruginosa > 0.05 Enterococcus faecalis > 0.05 No growth > 0.05

11 Discussion & Conclusion In this study, Mixed infection - treatment duration longer than other microorganism groups : 53.4 days Incidence of major amputation, complication More in mixed infection group The predominance of S.aureus is in agreement with the results of previous reported studys S.aureus : 58/114 (50.9%) - MSSA : 34 cases (29.8%) - MRSA : 24 cases (21.1%) The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillinsensitive Staphylococcus aureus Mixed bacterial infected patients have higher major amputation and complication rate, longer duration of treatment than the other bacterial infected patients group

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