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.
<Correlation between the
Treatment Result and Causative Bacteria
in Amputation of Diabetic Foot>
< Myoung Jin Lee M.D., Ki Woong Kim, M.D.>
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Purpose
To evaluate correlation
between the clinical results and causative bacteria
in diabetic foot patients with lower extremity amputation
Materials and Methods
Jan. 2008 ~ Jan. 2012
129 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
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
Materials and Methods
In culture,
MSSA : 34
MRSA : 24
Enterobacter cloacae : 12
Pseudomonas aeruginosa : 10
Mixed infection : 14
Enterococcus faecalis : 12
Other microorganisms : 8 Escherichia coli (3)
Acinetobacter baumanni (2)
Serratia marcescens (1)
Klebsiella pneumonia (2)
Proteus vulgaris (1)
Enterobacter aerogenes (2)
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
Results
Amputation
level
Additional amputation
Duration of treatment
Complication
Death
Patient’s satisfaction
Microorganism Major
(n)
Minor
(n)
Total P-value
MSSA 2 32 34 > 0.05
MRSA 4 19 24 > 0.05
Mixed infection 6 8 14 < 0.05
Enterobacter cloacae 0 12 12 > 0.05
Pseudomonas aeruginosa 0 10 10 > 0.05
Enterococcus faecalis 0 8 8 > 0.05
No growth 0 17 17 > 0.05
More major amputation in mixed infection group
Results
Amputation
level
Additional amputation
Duration of treatment
Complication
Death
Patient’s satisfaction
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
More complication in mixed infection group
Results
Amputation
level
Additional amputation
Duration of treatment
Complication
Death
Patient’s satisfaction
Microorganism Duration of
treatment (days)
Total P-value
MSSA 37.5 34 > 0.05
MRSA 41.5 24 > 0.05
Mixed infection 53.4 14 < 0.05
Enterobacter cloacae 36.8 12 > 0.05
Pseudomonas aeruginosa 35.5 10 > 0.05
Enterococcus faecalis 34.7 8 > 0.05
No growth 32.5 17 > 0.05
Longer duration of treatment in mixed infection group
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 Methicillin-
sensitive 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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