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J. Clin. Microbiol. doi:10.1128/JCM.00551-07
Copyright (c) 2007, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Bacteriology of Moderate to Severe Diabetic Foot Infections and In Vitro Activity of Antimicrobial Agents

R.M. Alden Research Lab, Santa Monica, CA; David Geffen School of Medicine, University of California, Los Angeles, CA; VA Puget Sound Health Care System, & Univ. of Washington School of Med., Seattle, WA; Merck & Co., Inc., Merck Research Laboratories, West Point, PA

^* To whom correspondence should be addressed. Email: d.m.citron{at}verizon.net.

	Abstract

As part of a United States-based multicenter clinical trial conducted 2001-2004 comparing ertapenem to piperacillin/tazobactam for treating moderate to severe diabetic foot infections (DFI), we obtained 454 pretreatment specimens from 433 patients. After debridement, investigators collected wound specimens, mostly by curettage or biopsy, and sent them to our laboratory for aerobic and anaerobic culture. Among the 427 positive cultures, 83.8% were polymicrobial, 48% grew only aerobes, 43.7% had both aerobes and anaerobes, and 1.3% only anaerobes. Cultures yielded a total of 1145 aerobic and 462 anaerobic strains with an average (range) of organisms per culture of 2.7 (1-8) for aerobes and 2.3 (1-9) for anaerobes. The predominant aerobic organisms were: Staphylococcus aureus, oxacillin-susceptible (14.3%), oxacillin-resistant, (4.4%); Staphylococcus species, coagulase-negative (15.3%); Streptococcus species (15.5%); Enterococcus species (13.5%); Corynebacterium species (10.1%); Enterobacteriaceae (12.8%), and Pseudomonas aeruginosa (3.5%). Predominant anaerobes were gram-positive cocci (45.2%), Prevotella species (13.6%), Porphyromonas species (11.3%), and Bacteroides fragilis group (10.2%). Pure cultures were noted for 20% of oxacillin-resistant Staphylococcus aureus, 9.2% of S. epidermidis, and 2.5% of P. aeruginosa. Two or more species of Staphylococcus were present in 13.1% of patients. Ertapenem and piperacillin/tazobactam were each active against >98% of enteric gram-negative rods, methicillin-sensitive S. aureus, and anaerobes. Among fluoroquinolones, 24% of anaerobes were resistant to moxifloxacin, especially the gram-positive cocci; 27% of gram-positive aerobes, but only 6% of Enterobacteriaceae, were resistant to levofloxacin. Moderate to severe DFIs are typically polymicrobial, and almost half include anaerobes. Our antibiotic susceptibility results can help to inform therapeutic choices.

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