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Wagner Evre III ve IV Diyabetik Ayak Ülserlerinin Mikrobiyolojik Değerlendirmesi

Microbiological Evaluation of Wagner Grade III and IV Diabetic Foot Ulcers

Journal Name:

Publication Year:

DOI: 
10.5505/abantmedj.2017.06078
Abstract (2. Language): 
INTRODUCTION: The aim of the study to investigate the cases of Wagner grade III and IV diabetic foot ulcers which need critical clinical and surgical intervention, regarding to the pathogen microorganism populations and their antibiotic resistances. METHODS: A total 90 cases consist of 48 grade III and 42 grade IV ulcers according to the Wagner classification were included to the study. The carts are reviewed retrospectively, and patients’ demographics and microbiological culture results were recorded for analysis. RESULTS: Results: Gram (-) microorganisms were isolated in 124 samples, Gram (+) microorganisms were isolated in 37 samples. E. Coli, P. aeruginosa, Staphylococcus aureus and Proteus mirabilis were the most frequently detected infectious agents. Enterococcus species showed 80%, staphylococcus showed as much as 42.8%, pseudomonas aeruginosa showed as much as 38.4%, E.coli showed as much as 64.5% drug resistance in the culture antibiogram studies. 31.6% of the isolated bacteria showed a multidrug resistance. DISCUSSION AND CONCLUSION: Surgeons should be aware of common antibiotic resistance in diabetic foot cases had Wangner grade III and IV ulcer which require surgical intervention.
Abstract (Original Language): 
GİRİŞ ve AMAÇ: Bu çalışmanın amacı patojen mikroorganizma popülasyonları ve antibiyotik dirençleri açısından kritik klinik ve cerrahi müdahale ihtiyacı duyulan Wagner evre III ve IV diyabetik ayak ülserli olguları incelemektir. YÖNTEM ve GEREÇLER: Gereç ve Yöntemler: Wagner sınıflamasına göre evre 48 evre III ve 42 evre IV olmak üzere toplam 90 diyabetik ayak ülserli olgu çalışmaya dahil edildi. Hasta kayıtları gözden geçirildi ve hasta bilgileri ile mikrobiyoloji kültür sonuçları analiz için kaydedildi. BULGULAR: Gram (-) mikroorganizmalar 124 örnekte ve Gram (+) mikroorganizmalar 37 örnekte izole edildi. E. Coli, P. aeruginosa, Staphylococcus aureus ve Proteus mirabilis en sık görülen enfeksiyon ajanları olarak tespit edildi. Kültür antibiyogram sonuçlarında Enterococcus türleri % 80, Staphylococcus % 42,8, pseudomonas aeruginosa % 38,4, E.coli ise % 64,5 antibiyotik direnci gösterdi. İzole edilen bakterilerin % 31,6’sı ise birden çok ilaca direnç gösterdi. TARTIŞMA ve SONUÇ: Cerrahlar, cerrahi müdahale gerektiren Wagner Evre III ve IV ülserli diyabetik ayak olgularında yaygın antibiyotik direncinin farkında olmalıdırlar.
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REFERENCES

References: 

1. Sapico FL, Bessman AN. Foot infections in the diabetic
patient. In: Gorbach SL, Bartlett JG, Blacklow NR, Eds.
Infectious Diseases. Second ed. Philadelphia: WB
Saunders, 1998:1270 – 2.
2. Lipsky BA. Osteomyelitis of the foot in diabetic patients.
Clin Infect Dis, 1997; 25:1318 – 26.
3. Albrant DH. Management of foot ulcers in patients with
Diabetes. J Am Pharm Assoc, 2000; 40: 467 – 74.
4. Satman İ, Şengül AM, Uygur S, Salman F, Baştar İ, Sargın
M, Tütüncü Y, Karşıdağ K, Dinççağ N, Özcan C et al. The
TURdep Group, Diyabetes Div. İstanbul Univ. State Inst.
Statistics and Min. Health – Turkey 36th EASD
Jarusalem,17-21 September 2000. Provisional Programme
p: 49. Diabetologia, 2000; Suppl 1.
5. Ertuğrul MB, Baktıroğlu S, Aksoy M, Çalangu S. Diyabetik
Ayak ve Enfeksiyonu. Klimik Dergisi, 2004; 17 : 3 -12.
6. Levin M.E. Foot Lesions in Patient with Diabetes Mellitus.
Endocrinol Metab Clin North Am 1996; 25: 447-462.
7. Boulton AJM: The importance of abnormal foot pressure
and gait in the causation of foot ulcers. In Connor H,
Boulton AJM, wards JD (edt). The Foot in Diabetes. John
Wiley & Sons. 1987; 11-21.
8. Wagner W F. The Dysvascular Foot: A System for diagnosis
and treatment. Foot Ankle 1981; 2: 62-122.
9. Ulusoy S. Diyabetik ayak enfeksiyonları. Modern Tıp
Seminerleri: 33: 2006; 40-45.
10. Bozkurt F, Tekin R, Çelen M.K, Ayaz C. Wagner
classification and culture analysis of diabetic foot
infection. Dicle Tıp Derg / Dicle Med J Cilt / Vol 38, No 1,
31-34.
11. Gough A, Clapperton M, Rolando N, Foster AV, Philpott-
Howard J, Edmonds ME: Randomised placebo-controlled
trial of granulocyte-colony stimulating factor in diabetic
foot infection. Lancet 1997; 350: 855-859.
12. Ulusoy S, Arda B, Bayraktar F, Sesli E, Özinel MA, Yamazhan
T, Ünal İ, Kısakol G, Tüzün M. Diyabetik ayak infeksiyonları:
179 olgunun değerlendirilmesi. Flora 2000; 5: 220-228.
13. Grayson ML: Diabetic foot infections-antimicrobial
therapy. Infect Dis Clin North Am l995;9: 143-161. 81
14. Armstrong DG, Lipsky BA. Advances in the treatment of
diabetic foot infections. Diyabetes Technol Ther 2004;
6(2):167-177
15. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS,
Karchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C et
al. Diagnosis and treatment of diabetic foot infections.
Guidelines for Diabetic Foot Infections. CID, 2004; 39 (1
October): 885 – 910.
16. Ansari MA, Shukla VK. Foot Infections. Int J Low Extremy
Wounds, 2005; 4(2): 74 – 87.
17. Brodsky J, Schneidler C. Diabetic foot infections. Orthop
Clin North Am 1991; 22(3):473-489.
18. Shea KW. Antimicrobial therapy for diabetic foot
infections. A practical approach. Postgrad Med 1999;
106(1):1-10.
19. Lipsky BA. Pecorato RE, Wheat LJ. The diabetic foot. Soft
tissue and bone infection, Infect Dis Clin North Am 1990;
4: 409-432
20. Wheat LJ, Ailen SD, Henry M, Kerek CB, Siders Ja, Kuebler
T, Fineberg N,Norton J. Diabetic foot infections -
Bacteriologic analysis. Arch Intern Med 1986;146: 1935-
38.
21. Bamberger DM, Daus GP, Gerding DN. Osteomyelitis in the
feet of diabetic patients. Am J Med 1987; 83:653-55.
22. Hollinworth H. Managing a patient with an infected foot
ulcer. J wound Care 1993; 2: 22-26.
23. Joseph WS; Treatment of lower extremity infections in
diabetics. Drugs 1991; 42: 984-86
24. West NJ. Systemic antimicrobial treatment of foot
infections in diabetic patients. Am J Health Syst Pharm
1995;52: 1199-1202.
25. Slater R, Lazarovich T, Boldur I, Ramot Y, Buchs A, Weiss
M, Hindi A, Rapoport MJ. Swab culteres accurately identify
bacterial pathogens in diabetic foot wounds not involving
bone. Diabet Med 2004; 21: 705-709
26. Pellizzer G, Strazzabosco M, Presi S, Furlan F, Lora L,
Benedetti P, Bonato M, Erle G, de Lalla F. Deep tissue
biopsy vs. superficial swab culture monitoring in the microbiological
assessment of limb-threatening diabetic foot
infection. Diabet Med 2001; 18:822-827.
27. Ertuğrul MB. Diyabetik Ayak Enfeksiyonlarında Kemik
Doku ve Yumuşak Dokudan İzole Edilen İnfeksiyon Etkeni
Mikroorganizmaların Karşılaştırılması Uzmanlık Tezi.
İstanbul. İstanbul Üniversitesi İstanbul Tıp Fakültesi, 2003.
28. Sapico FL, Bessman AN. Quantitative aerobic and anaerobic
bacteriology of infected diabetic feet. J Clin Microbiol
1980; 4:413-420.
Tekin F ve ark.
Abant Med J 2017;6(2):38-47 47
29. Pathare NA, Bal A, Talvalkar GV, Antani DU. Diabetic foot
infections: a study of microorganisms associated with the
different wagner grades. Indian J Pathol Microbiol 1998;
41: 437-441.
30. Frykberg RG, Armstrong DG, Giurini J, Edwards A, Krawette
M, Kravitz S, Ross C, Stavosky J, Stuck R, Vanore J. Diabetic
foot disorders. A Clinical Practice Guideline. J Foot Ankle
Surg 2000; 39: Supplement.
31. Ge Y, MacDonald D, Hait H, Lipsky BA. Microbiological
profile of infected diabetic foot ulcers. Diabet Med, 2002;
19:1032 – 1035.
32. Sert M, Tetiker T, Koçak M, Aksu HSZ. Diyabetik ayak
enfeksiyonlarında ampirik antibiyotik kullanılması.
Endokrinolojide Yönelişler, 2000; 9 : 47- 49.
33. Motta RN, Oliveira MM, Megahaes PS, Dias AM, Araqao
LP, Forti AC, Carvalho CB. Plasmid mediated extended
spectrum beta lactamase producing strains of
Enterobacteriacea isolated from diabetic foot infections in
a Brasilian diabetic center. Braz J Infect Dis, 2003; 7: 129 –
34.
34. Tentolouris N, Petrikkos G, Vallianou N, Zachos G, Daikos
GL, Tsapogas P, Markou G, Katsilambros N. Prevalance of
methicillin-resistant Staphylococcus aureus in infected
and uninfected diabetic foot ulcers. Clin Microbiol Infect,
2006; 12: 178 – 196.
35. Zeillemaker AM, Veldkamp KE. Piperacillin – Tazobactam
therapy for diabetic foot infection. Foot Ankle Int, 1998;
19(3):169-172.
36. Grayson ML, Gibbons GW, Habershaw GM, Freeman DV,
Pomposelli FB, Rosenblum BI, Levin E, Karchmer AW. Use
of ampicillin/sulbactam versus imipenem/cilastatin in the
treatment of limb-threatining foot infections in diabetic
patients. Clin Infect Dis, 1994; 18: 683 – 693.
37. Bridges RM, Deitch EA. Diabetic foot infections. Surg Clin
North Am. 1994; 74 : 537-555.
38. Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA
Bacteriological study of diabetic foot infections. J Diabetes
Complications 2005; 19:138-141.
39. Özkan, Y., R. Çolak, K. Demirdağ, M. A. Yıldırım, G. Özalp,
S. S. Koca. Diyabetik ayak sendromlu 142 olgunun
retrospektif değerlendirilmesi. Türkiye Klinikleri J Endocrin
2004; 2:191-195.
40. Boutoille D, Leautez S, Maulaz D, Krempf M, Raffi F. Skin
and osteoarticular bacterial infections of the diabetic foot.
Treatment. Presse Med 2000; 29: 396-400.
41. Örmen B, Türker N, Vardar İ. Diyabetik ayak
infeksiyonlarının klinik ve bakteriyolojik değerlendirilmesi.
İnfeksiyon Derg 2007; 21: 65-69

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