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단일 3차 의료기관에 내원한 당뇨병성 족부병변 환자의 창상 배양검사를 통한 세균 검출 현황

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

이상윤|이명진|정성윤|이승엽
대한족부족관절학회 (korean foot and ankle society)|2021.06|대한족부족관절학회지 (journal of korean foot and ankle society)|제25권 제2호|pp. 100-107|DOI 10.14193/jkfas.2021.25.2.100

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키워드

AntibioticsDiabetic foot ulcerBacterial cultureWagner gradeResistant bacteria

초록

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investi￾gating 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 ac￾cording 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 gram￾positive 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.

Abstract

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investi￾gating 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 ac￾cording 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 gram￾positive 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.

참고문헌 (19)

  1. Lawrence A. Lavery, "Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort", Diabetes Care, 26(5), pp.1435~1438 (2003), American Diabetes Association[DOI]
  2. J. APELQVIST, "Diabetic foot ulcers in a multidisciplinary setting An economic analysis of primary healing and healing with amputation", Journal of Internal Medicine, 235(5), pp.463~471 (1994), Wiley[DOI]
  3. Timothy K. Fisher, "A step-wise approach for surgical management of diabetic foot infections", Journal of Vascular Surgery, 52(3 Suppl), pp.72S~75S (2010), Elsevier BV[DOI]
  4. B. M. Ertugrul, "A prospective, multi-center study: factors related to the management of diabetic foot infections", European Journal of Clinical Microbiology & Infectious Diseases, 31(9), pp.2345~2352 (2012), Springer Science and Business Media LLC[DOI]
  5. Ioanna Eleftheriadou, "Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infections", Drugs, 70(14), pp.1785~1797 (2010), Springer Science and Business Media LLC[DOI]
  6. Ihm CG, "Diabetic nephropathy", Korean J Med, 59, pp.367~376 (2000)
  7. M. Kaminski, "Prevalence of risk factors for foot ulceration in patients with end-stage renal disease on haemodialysis", Internal Medicine Journal, 42(6), pp.e120~e128 (2012), Wiley[DOI]
  8. David J. Margolis, "Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes", Diabetes Care, 31(7), pp.1331~1336 (2008), American Diabetes Association[DOI]
  9. Yrjö Leskinen, "The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics", American Journal of Kidney Diseases, 40(3), pp.472~479 (2002), Elsevier BV[DOI]
  10. L. Prompers, "High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study", Diabetologia, 50(1), pp.18~25 (2007), Springer Science and Business Media LLC[DOI]
  11. Kang MJ, "The impact of peripheral arterial disease on the treatment and amputation of diabetic foot ulcer", J Korean Soc Vasc Surg, 24, pp.113~118 (2008)
  12. Jason H. Calhoun, "Treatment of Diabetic Foot Infections: Wagner Classification, Therapy, and Outcome", Foot & Ankle, 9(3), pp.101~106 (1988), SAGE Publications[DOI]
  13. Amy E. Kirby, "The Relative Contributions of Physical Structure and Cell Density to the Antibiotic Susceptibility of Bacteria in Biofilms", Antimicrobial Agents and Chemotherapy, 56(6), pp.2967~2975 (2012), American Society for Microbiology[DOI]
  14. Bernstein BH, "Combination of subatmospheric pressure dressing and gravity feed antibiotic instillation in the treatment of postsurgical diabetic foot wounds: a case series", Wounds, 17, pp.37~48 (2005)
  15. Benotmane A, "Diabetic foot lesions : etiologic and prognostic factors", Diabetes Metab, 26, pp.113~117 (2000)
  16. Joon Young Song, "Antimicrobial Therapy in Diabetic Foot Infections", Journal of Korean Diabetes, 12(2), pp.83~87 (2011), Korean Diabetes Association[DOI]
  17. 서유빈, "감염성 당뇨 족부 궤양: 심부 조직 배양 검사 결과에 기초한 원인균 분석", Infection and Chemotherapy, 39(5), pp.237~242 (2007), 대한감염학회
  18. 박세진, "감염된 당뇨병성 족부 병변의 균주 조사 및 항생제 선택", 대한족부족관절학회지, 13(2), pp.150~155 (2009), 대한족부족관절학회
  19. Javier Aragón-Sánchez, "Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation", The International Journal of Lower Extremity Wounds, 12(1), pp.63~68 (2013), SAGE Publications[DOI]

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