The microbiology of diabetic foot infection

Diabetic Foot, The,  Winter, 2003  

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It is important to check the antimicrobial sensitivities of MRSA strains because these vary. Because of multiple resistance we are becoming more and more dependent on the use of glycopeptides, teicoplanin and vancomycin. These are intravenous drugs, and because vancomycin has toxic side-effects, serum monitoring is required.

Trimethoprim, rifampicin and fucidin can be given if the MRSA is sensitive, and because they are also available orally, they are useful for outpatient therapy. However, rifampicin and fucidin must be used in combination because resistance develops to them rapidly when they are used alone.

The oxazolidinone, linezolid, is a new agent that is effective as monotherapy against all strains of MRSA and shows no cross-resistance with other agents. It can be given orally as well as intravenously and may have an increasing role in treatment.

Conclusions

Professor French concluded with the following points:

* True infections should be treated first with general support, then debridement and drainage, and finally with antibiotic treatment.

* Oral antibiotics at home can be used for limb non-threatening infections but intravenous therapy in hospital is needed for severe limb-threatening infections in hospital.

* A good specimen should be sent to the laboratory.

* Initial treatment should be based on the 'best guess' of the organisms involved and therapy later adjusted according to the microbiology test results.

* S aureus is probably the most common and important true pathogen.

* Complicated patients have polymicrobial and resistant infection, and MRSA is an increasing problem. Antimicrobial therapy should be chosen to cover the likely pathogens involved.

COPYRIGHT 2003 S.B. Communications
COPYRIGHT 2004 Gale Group