J Korean Foot Ankle Soc.  2021 Jun;25(2):100-107. 10.14193/jkfas.2021.25.2.100.

The Current Status of Bacterial Identification by Wound Culture for Diabetic Foot Lesions in a Single Tertiary Hospital in South Korea

• Jung SY
• Lee MJ
• Lee SY
• Lee SY

• KMID: 2516648
• DOI: http://doi.org/10.14193/jkfas.2021.25.2.100

Abstract

Purpose
The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates.
Materials and Methods
This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification.
Results
Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to grampositive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios.
Conclusion
This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

Keyword

Diabetic foot ulcer; Bacterial culture; Wagner grade; Resistant bacteria; Antibiotics

Figure

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  Figure. 1 This figure demonstrates isolation rate of each comorbidity group. Isolation rate of gram-positive, gram-negative, and non-isolation rate of each comorbidity group (group A~D).

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  Figure. 2 This figure demonstrates isolation rate of resistant bacteria of each comorbidity group. Isolation rate of MSSA, MRSA, MRGNB, and ESBL-producing bacteria of each comorbidity group (group A~D). MSSA: methicillin-sensitive Staphylococcus aureus, MRSA: methicillin-resistant Staphylococcus aureus, MRGNB: multidrug-resistant gram-negative bacteria, ESBL: extended spectrum beta-lactamase.

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  Figure. 3 This figure demonstrates isolation rate among grades by Wagner classification. Isolation rate of gram-positive, gram-negative, and non-isolation rate of each grade by Wagner classification (grade I~V).

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  Figure. 4 This figure demonstrates isolation rate of resistant bacteria among grades by Wagner classification. Isolation rate of MSSA, MRSA, MRGNB, and ESBL-producing bacteria of each grade by Wagner classification (grade I~V). MSSA: methicillin-sensitive Staphylococcus aureus, MRSA: methicillin-resistant Staphylococcus aureus, MRGNB: multidrug-resistant gram-negative bacteria, ESBL: extended spectrum beta-lactamase.

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