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Bacteriology

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

Diane M. Citron, Ellie J. C. Goldstein, C. Vreni Merriam, Benjamin A. Lipsky, Murray A. Abramson
Diane M. Citron
1R. M. Alden Research Laboratory, Santa Monica, California
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  • For correspondence: d.m.citron@verizon.net
Ellie J. C. Goldstein
1R. M. Alden Research Laboratory, Santa Monica, California
2David Geffen School of Medicine, University of California, Los Angeles, California
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C. Vreni Merriam
1R. M. Alden Research Laboratory, Santa Monica, California
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Benjamin A. Lipsky
3VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington
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Murray A. Abramson
4Merck & Co., Inc., Merck Research Laboratories, West Point, Pennsylvania
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DOI: 10.1128/JCM.00551-07
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Tables

  • TABLE 1.

    Characteristics of diabetic foot specimens taken prior to antimicrobial therapy

    CharacteristicValue
    Total no. of specimens454
        No. (%) with aerobes only222 (48.9)
        No. (%) with anaerobes only6 (1.3)
        No. (%) with mixed growth199 (43.8)
        No. (%) with no growth27 (5.9)
        No. of positive cultures427
        No. of patients with positive cultures406
    No. (%) of positive cultures with:
        One isolate69 (16.2)
        Two isolates87 (20.4)
        Three isolates84 (19.7)
        Four isolates57 (13.3)
        More than four isolates130 (30.4)
    Total no. of aerobes1,145
        No. of different species115
        Range of no. of aerobes per specimen0-8
        Avg no. of aerobes per positive specimen2.7
        No. (%) of positive specimens in pure culture64 (15.2)
    Total no. of anaerobes462
        No. of different species74
        Range of no. of anaerobes per specimen0-9
        Avg no. of anaerobes per positive specimen2.3
        No. (%) of positive specimens in pure culture3 (1.5)
    Total no. of all isolates1,607
  • TABLE 2.

    Comparative frequency of groups of species by specimen collection type

    OrganismNo. of isolates (% of specimens yielding the groupa) obtained by or with:
    Total (n = 454)Aspiration (n = 52 [11.5b])Swab (n = 132 [29.1])Tissue (n = 258 [56.8])Not specified (n = 12 [2.6])
    Aerobes
        Nonfermenting gram-negative rods35 (7.7)5 (9.6)10 (7.6)18 (7.0)2 (16.7)
        Pseudomonas spp.42 (9.3)3 (5.8)15 (11.4)24 (9.3)0
        Enterobacteriaceae group147 (32.4)16 (30.8)45 (34.1)85 (32.9)1 (8.3)
        Corynebacterium spp.116 (25.6)7 (13.5)32 (24.2)72 (27.9)5 (41.7)
        Miscellaneous gram-positive rods53 (11.7)3 (5.8)18 (13.6)32 (12.4)0
        Enterococcus spp.154 (33.9)10 (19.2)56 (42.4)84 (32.6)4 (33.3)
        Staphylococcus spp.388 (85.5)34 (65.4)107 (81.1)237 (91.9)10 (83.3)
        S. aureus, Ox-Rc53 (11.7)4 (7.7)20 (15.2)24 (9.3)1 (8.3)
        S. aureus, Ox-Sd164 (36.1)22 (42.3)46 (34.8)93 (36.0)3 (25.0)
        S. epidermidis72 (15.9)2 (3.8)21 (15.9)47 (18.2)2 (16.7)
        S. epidermidis, Ox-R15 (3.3)06 (4.5)9 (3.5)
        S. haemolyticus22 (4.8)1 (1.9)4 (3.0)16 (6.2)1 (8.3)
        S. lugdunensis22 (4.8)1 (1.9)4 (3.0)14 (5.4)3 (25.0)
        Other coagulase-negative staphylococci36 (7.9)3 (5.8)7 (5.3)26 (10.1)
        Streptococcus spp.190 (41.9)23 (44.2)48 (36.4)110 (42.6)9 (75.0)
    Anaerobes
        Bacteroides fragilis group55 (12.1)4 (7.7)16 (12.1)32 (12.4)3 (25.0)
        Fusobacterium spp.11 (2.4)1 (1.9)3 (2.3)7 (2.7)
        Porphyromonas spp.53 (11.7)4 (7.7)12 (9.1)37 (14.3)
        Prevotella spp.64 (14.1)2 (3.8)15 (11.4)46 (17.8)1 (8.3)
        Anaerobic cocci219 (48.2)14 (26.9)65 (49.2)133 (51.6)7 (58.3)
        Clostridium spp.20 (4.4)3 (5.8)7 (5.3)10 (3.9)
        Non-spore-forming, gram-positive rods43 (9.5)2 (3.8)11 (8.3)29 (11.2)1 (8.3)
    • ↵ a Percent represents the percentage of each type of specimen yielding the indicated organism group.

    • ↵ b Values in brackets are the percentage of all specimens.

    • ↵ c Ox-S, oxacillin sensitive.

    • ↵ d Ox-R, oxacillin resistant.

  • TABLE 3.

    Distribution of 462 anaerobes and 1,145 aerobes isolated from DFIs

    OrganismNo. isolated% Total aerobes or anaerobes% in genus% Total isolatesNo. (%) of patientsaNo. (%) in pure culture
    All gram-positive aerobes92080.357.1394 (97.0)63 (6.8)
        Staphylococcus spp.38934.024.1328 (80.8)
            OSSAb16414.342.210.2162 (39.9)26 (15.9)
            ORSAc504.412.93.148 (11.8)10 (20)
            S. epidermidis (15 MRSEd strains)877.622.45.481 (20.0)8 (9.2)
            S. lugdunensis221.95.71.422 (5.4)2 (9.1)
            S. haemolyticus221.95.71.420 (4.9)1 (4.5)
            S. simulans121.03.10.712 (3.0)2 (16.7)
            Other Staphylococcus spp.322.88.22.031 (7.6)2 (9.4)
        Streptococcus spp.17715.510.5168 (41.1)
            S. agalactiae867.548.65.282 (20.2)3 (3.5)
            S. mitis group413.623.22.538 (9.4)2 (4.9)
            S. milleri group191.710.71.117 (4.2)
            S. dysgalactiae subsp. equisimilis181.610.21.118 (4.4)
            Other Streptococcus spp., including S. pyogenes (n = 3)131.17.31.113 (3.2)
        Miscellaneous gram-positive cocci272.41.71 (3.7)
        Enterococcus spp.15513.59.6145 (35.7)
            E. faecalis13812.189.08.6128 (31.5)1 (0.7)
            Other Enterococcus spp.171.511.01.117 (4.2)1 (5.9)
        Corynebacterium spp.11610.17.2115 (28.3)
            C. amycolatum494.342.2346 (11.3)1 (2.0)
            C. striatum302.625.91.929 (7.1)
            Other Corynebacterium spp.373.231.92.337 (9.1)1 (2.7)
        Dermabacter hominis151.311.50.915 (3.4)
        Actinomyces-Arcanobacterium group131.1
        Other gram-positive rods252.21 (4.0)
    All gram-negative aerobic organisms22519.714.0145 (35.7)3 (1.3)
        Escherichia coli201.78.91.220 (4.9)
        Klebsiella spp.252.211.11.625 (6.2)
        Enterobacter cloacae201.78.91.220 (4.9)1 (5.0)
        Enterobacter-Citrobacter-Pantoeae group161.47.11.013 (3.2)1 (6.3)
        Serratia marcescens141.26.20.914 (3.4)
        Proteus-Providencia-Morganella group282.412.41.725 (6.2)
        Proteus mirabilis242.110.71.523 (5.7)
        Pseudomonas aeruginosa403.517.82.535 (8.6)1 (2.5)
        Stenotrophomonas maltophilia151.36.70.915 (3.7)
        Alcaligenes faecalis group100.94.40.69 (2.2)
        Other nonfermenting gram-negative rods131.15.80.813 (3.2)
    All anaerobic organisms46228.7e199 (49.0)3 (0.6)
        Bacteroides fragilis group4710.22.934 (8.4)
            B. fragilis194.140.4
            B. caccae20.44.3
            B. distasonis10.22.1
            B. ovatus51.110.6
            B. stercoris20.44.3
            B. thetaiotaomicron81.717.0
            B. uniformis51.110.6
            B. vulgatus51.110.6
        Prevotella spp.6313.63.950 (12.3)
            P. melaninogenica112.417.210 (2.5)
            Prevotella spp., pigmented102.215.6
            Prevotella bivia265.841.326 (6.4)
            Prevotella spp., nonpigmented163.525.0
        Porphyromonas spp.5211.33.342 (10.3)
            P. asaccharolytica296.355.828 (6.9)
            P. somerae (formerly P. levii)214.539.620 (4.9)
            Other Porphyromonas spp.20.43.8
        Fusobacterium spp.112.40.710 (2.5)
            F. nucleatum81.772.7
            F. mortiferum-F. varium group30.627.2
        Other gram-negative species132.80.8
        Anaerobic gram-positive cocci20945.213.0152 (37.4)
            Finegoldia magna10222.148.86.499 (24.4)
            Peptoniphilus asaccharolyticus378.017.737 (9.1)
            Peptostreptococcus anaerobius153.27.214 (3.4)
            Anaerococcus prevotii132.86.213 (3.2)1 (7.7)
            Anaerococcus tetradius91.94.39 (2.2)
            Peptostreptococcus micros61.32.96 (1.5)
            Other species275.812.927 (6.7)
        Clostridium spp.204.31.220 (4.9)
            C. innocuum10.25.0
            C. clostridioforme group30.615.0
            C. perfringens61.330.0
            Other Clostridium spp.102.150.0
        Eubacterium group173.71.117 (4.2)
        Other gram-positive, non-spore-forming rodsf306.51.92 (6.7)
    • ↵ a A total of 406 patients had positive cultures.

    • ↵ b OSSA, oxacillin-sensitive S. aureus.

    • ↵ c ORSA, oxacillin-resistant S. aureus.

    • ↵ d MRSE, methicillin-resistant S. epidermidis.

    • ↵ e Of a total of 1,607 isolates.

    • ↵ f Including Lactobacillus spp., Propionibacterium spp., and Actinomyces spp.

  • TABLE 4.

    In vitro activities of antimicrobial agents against gram-positive aerobic organisms

    Organism (no. of isolates)MIC50/MIC90 (μg/ml [% susceptible])a
    ETPP/TA/CCFLCIPLVXMXFDOXCMT/S
    Corynebacterium amycolatum (49)2/>16 (69)≤2/>32 (78)≤1/>8 (78)≤2/>32 (55)8/>8 (27)8/>8 (27)2/>4 (57)≤2/16 (80)8/>8 (10)2/>4 (51)
    Corynebacterium spp. and other non-spore-forming gram-positive rodsb (120)≤0.25/2 (93)≤2/>32 (78)≤1/4 (91)≤2/>32 (74)4/>8 (50)2/>8 (54)0.5/>4 (74)≤2/8 (87)8/>8 (30)4/>4 (49)
    Enterococcus spp.c (155)8/16 (10)≤2/>32 (97)≤1/≤1 (99)>32/>32 (5)1/>8 (68)1/>8 (77)0.5/>4 (80)4/8 (63)>8/>8 (1)≤0.5/4 (90)
    Staphylococcus aureus, Ox-Rd (49)4/>16 (NIe)8/32 (NI)8/>8 (NI)>32/>32 (NI)>8/>8 (12)>8/>8 (16)4/>4 (16)≤2/≤2 (94)>8/>8 (47)≤0.5/≤0.5 (90)
    S. aureus, Ox-Sf (169)≤0.25/≤0.25 (100)≤2/≤2 (100)≤1/≤1 (100)≤2/4 (99)≤0.5/1 (94)≤0.5/≤0.5 (96)≤0.25/≤0.25 (95)≤2/≤2 (95)≤0.25/≤0.25 (98)≤0.5/≤0.5 (98)
    S. epidermidis (89)2/8 (87)≤2/≤2 (97)≤1/2 (99)16/32 (37)≤0.5/>8 (54)≤0.5/8 (57)≤0.25/2 (63)≤2/8 (90)≤0.25/>8 (89)≤0.5/>4 (67)
    S. haemolyticus (22)2/>16 (68)≤2/>32 (68)≤1/>8 (68)>32/>32 (14)>8/>8 (18)8/>8 (23)1/>4 (23)≤2/32 (55)≤0.25/>8 (77)≤0.5/>4 (68)
    S. lugdunensis (23)≤0.25/≤0.25 (100)≤2/≤2 (100)≤1/≤1 (100)4/16 (83)≤0.5/≤0.5 (100)≤0.5/≤0.5 (100)≤0.25/≤0.25 (100)≤2/≤2 (100)≤0.25/≤0.25 (91)≤0.5/≤0.5 (100)
    Coagulase-negative Staphylococcus spp.g (44)0.5/4 (93)≤2/≤2 (98)≤1/2 (100)≤2/>32 (77)≤0.5/>8 (80)≤0.5/>8 (82)≤0.25/4 (82)≤2/4 (96)≤0.25/>8 (84)≤0.5/1 (91)
    Streptgcoccus spp.h (173)≤0.25/≤0.25 (100)≤2/≤ (100)≤1/≤1 (99)≤2/8 (93)≤0.5/4 (71)≤0.5/2 (97)≤0.25/0.5 (97)8/16 (40)≤.25/>8 (90)≤0.5/≤0.5 (95)
    • ↵ a ETP, ertapenem; P/T, piperacillin-tazobactam; A/C, amoxicillin-clavulanic acid; CFL, cephalexin; CIP, ciprofloxacin; LVX, levofloxacin; MXF, moxifloxacin; DOX, doxycycline; CM, clindamycin; T/S, trimethoprim-sulfamethoxazole.

    • ↵ b Corynebacterium striatum (n = 31), Corynebacterium accolens (n = 1), Corynebacterium aurimucosum (n = 5), Corynebacterium glucuronolyticum (n = 2), Corynebacterium jeikeium (n = 5), Corynebacterium minutissimum (n = 1), Corynebacterium pseudodiphtheriticum (n = 1), “Corynebacterium pseudogenitalium” (n = 2), Corynebacterium pseudotuberculosis (n = 1), Corynebacterium simulans (n = 4), Corynebacterium tuberculostearicum (n = 7), Corynebacterium urealyticum (n = 1), Corynebacterium xerosis (n = 4), Corynebacterium spp. (n = 2), Dermabacter hominis (n = 15), Actinobaculum massiliae (n = 1), Actinomyces neuii subsp. anitratus (n = 2), A. neuii subsp. neuii (n = 1), A. turicensis (n = 2), Arcanobacterium bernardiae (n = 5), Arcanobacterium hemolyticum (n = 3), Arthrobacter albus (n = 2), Arthrobacter creatinolyticus (n = 1), Bacillus cereus (n = 2), Bacillus pumilus (n = 2), Bacillus sp. (n = 1), Bifidobacterium urinalis (n = 1), Brachybacterium sp. (n = 1), Brevibacterium lutoleum (n = 1), Brevibacterium otitidis (n = 1), Brevibacterium spp. (n = 2), Lactobacillus gasseri (n = 1), Lactobacillus jensenii (n = 1), Microbacterium oxydans (2), Paenibacillus sp. (n = 1), Propionibacterium acnes (n = 1) and Propionibacterium avidum (n = 1) (both aerobic), “Zimmermannella bifida” (n = 1), and gram-positive bacilli with no sequence match (n = 2).

    • ↵ c Enterococcus faecalis (n = 139), E. avium (n = 3), E. canis (n = 2), E. casseliflavus (n = 1), E. faecium (n = 5), E. gallinarum (n = 4), and Enterococcus sp. (n = 1).

    • ↵ d Ox-S, oxacillin sensitive.

    • ↵ e NI, no interpretation.

    • ↵ f Ox-R, oxacillin resistant.

    • ↵ g Staphylococcus. auricularis (n = 1), S. capitis (n = 2), S. caprae (n = 3), S. cohnii (n = 4), S. hominis (n = 5), S. schleiferi (n = 1), S. sciuri (n = 9), S. simulans (n = 12), S. warneri (n = 4), S. xylosus (n = 1), and Staphylococcus spp. with no sequence match (n = 2).

    • ↵ h Streptococcus agalactiae (n = 85), S. anginosus (n = 17), S. bovis (n = 1), S. canis (n = 1), S. constellatus (n = 2), S. dysgalactiae subsp. equisimilis (n = 19). S. gordonii (n = 1), S. infantarius (n = 1), S. mitis group (n = 41), S. minor (n = 1), S. pyogenes (n = 3), and S. salivarius (n = 1).

  • TABLE 5.

    In vitro activities of antimicrobial agents against gram-negative aerobic organisms

    Organism (no. of isolates)MIC50/MIC90 (μg/ml [% susceptible])a
    ETPIPMP/TA/CCFLCAZCIPLVXMXFGMAMKDOXT/S
    Enterobacteriaceae groupb (98)≤0.125/≤0.125 (99)0.25/2 (100)≤1/4 (96)8/>64 (55)8/>32 (52)≤0.5/≤0.5 (94)≤0.5/≤0.5 (94)≤0.5/1 (94)≤0.25/2 (94)≤2/≤2 (95)≤8/≤8 (99)2/16 (79)≤0.5/>4 (90)
    Proteus-Providencia-Morganella groupc (55)≤0.125/≤0.125 (98)4/4 (100)≤1/≤1 (98)8/>64 (58)≤0.5/8 (93)≤0.5/≤0.5 (95)≤0.5/≤0.5 (95)≤0.25/2 (91)≤2/≤8 (98)≤2/≤2 (100)>32/>32 (22)≤0.5/>4 (91)
    P. aeruginosa (43)8/16 (NId)1/4 (86)4/16 (98)1/4 (98)≤.5/1 (91)≤.5/8 (79)1/8 (74)≤2/4 (95)≤8/≤8 (100)
    S. maltophilia (15)>16 (NI)>16 (NI)>128/>128 (NI)64/64 (NI)8/>32 (53)2/>8 (NI)1/>8 (80)0.5/4 (NI)>32/>32 (NI)128/>128 (NI)4/4 (NI)>4/>4 (20)
    Miscellaneous nonfermenting gram-negative rodse (24)≤.125/>16 (63)0.25/4 (92)≤1/>128 (79)4/>64 (67)4/>32 (79)1/>8 (58)≤0.5/>8 (83)1/>8 (71)≤2/8 (83)≤1/128 (79)≤1/>32 (75)≤0.5/>4 (75)
    • ↵ a ETP, ertapenem; IPM, imipenem; P/T, piperacillin-tazobactam; A/C, amoxicillin-clavulanic acid; CFL, cephalexin; CAZ, ceftazidime; CIP, ciprofloxacin; LVX, levofloxacin; MXF, moxifloxacin; GM, gentamicin; AMK, amikacin; DOX, doxycycline; T/S, trimethoprim-sulfamethoxazole.

    • ↵ b Escherichia coli (n = 20), Enterobacter cloacae (n = 21), Enterobacter aerogenes (n = 7), Enterobacter gergoviae (n = 1), Enterobacter intermedius (n = 1), Citrobacter freundii (n = 1), Citrobacter koseri (n = 4), Klebsiella oxytoca (n = 16), Klebsiella pneumoniae (n = 9), Pantoeae agglomerans (n = 3), and Serratia marcescens (n = 15).

    • ↵ c Proteus mirabilis (n = 26), Proteus vulgaris (n = 4), Providencia rettgeri (n = 6), Providencia rustigianii (n = 1), Providencia stuartii (n = 1), and Morganella morganii (n = 17).

    • ↵ d NI, no interpretation.

    • ↵ e Alcaligenes faecalis (n = 10), Acinetobacter baumannii (n = 6), Acinetbacter calcoaceticus (n = 1), Brevundimonas diminuta (n = 1), Chryseobacterium sp. (n = 1), Myroides odoratum (n = 1), Paracoccus sp. (n = 1), Pseudomonas fluorescens (n = 2), and Shewanella putrefaciens (n = 1).

  • TABLE 6.

    In vitro activities of antimicrobial agents against anaerobic organisms

    Organism (no. of isolates)MIC50/MIC90 (μg/ml [% susceptible])a
    ETPP/TA/CCMLVXMXF
    Bacteroides fragilis groupb (51)0.5/4 (100)2/8 (100)0.5/8 (80)1/>32 (67)8/>16 (33)2/>16 (57)
    Fusobacterium spp.c (10)≤.015/0.25 (100)≤0.06/2 (100)≤0.06/0.5 (100)≤0.06/2 (90)0.5/4 (80)0.25/2 (90)
    Porphyromonas spp.d (53)≤0.015/≤0.015 (100)≤0.06/≤0.06 (100)≤0.06/0.125 (100)≤0.06/>32 (87)0.5/2 (91)0.5/1 (98)
    Prevotella spp.e (66)0.125/0.25 (100)≤0.06/≤0.06 (100)≤0.25/2 (100)≤0.06/>32 (77)2/>16 (45)2/>16 (64)
    Clostridium spp.f (20)0.03/1 (100)0.125/4 (100)≤0.06/0.5 (100)1/8 (80)0.25/16 (80)0.5/8 (80)
    Finegoldia magna (110)0.06/0.125 (100)≤0.06/0.125 (100)0.125/0.25 (100)0.5/8 (81)8/>16 (40)2/16 (64)
    Peptoniphilus asaccharolyticus (40)≤0.015/0.125 (100)≤0.06/0.125 (100)≤0.06/0.25 (100)0.25/>32 (78)4/>16 (35)0.5/16 (78)
    Miscellaneous gram-positive coccig (77)0.06/0.25 (100)≤0.06/0.5 (100)≤0.06/0.25 (100)0.125/4 (90)4/>16 (62)1/16 (82)
    Miscellaneous gram-positive rodsh (49)0.06/0.5 (100)≤0.06/4 (96)≤0.06/0.5 (100)≤0.06/>32 (84)0.5/8 (80)0.5/4 (88)
    • ↵ a ETP, ertapenem; P/T, piperacillin-tazobactam; A/C, amoxicillin-clavulanic acid; CM, clindamycin; LVX, levofloxacin; MXF, moxifloxacin.

    • ↵ b Bacteroides caccae (n = 2), B. distasonis (n = 1), B. fragilis (n = 19), B. ovatus (n = 7), B. stercoris (n = 4), B. thetaiotaomicron (n = 8), B. uniformis (n = 5), and B. vulgatus (n = 5).

    • ↵ c Fusobacterium nucleatum (n = 7) and Fusobacterium varium (n = 3).

    • ↵ d Porphyromonas asaccharolytica (n = 30), P. somerae (n = 21), P. catoniae (n = 1), and P. endodontalis (n = 1).

    • ↵ e Prevotella bivia (n = 29), P. corporis (n = 6), P. disiens (n = 5), P. enoeca (n = 1), P. intermedia (n = 3), P. melaninogenica (n = 11), P. oralis (n = 1) P. oris (n = 2), P. pallens (n = 1), P. tannerae (n = 2), P. veroralis (n = 1), and Prevotella spp. (n = 4).

    • ↵ f Clostridium aminovalericum (n = 1), C. cadaveris (n = 4), C. clostridioforme (n = 3), C. innocuum (n = 1), C. malenominatum (n = 1), C. perfringens (n = 6), C. septicum (n = 1), C. sphenoides (n = 1), and C. subterminale (n = 2).

    • ↵ g Peptostreptococcus anaerobius (n = 15), Peptostreptococcus micros (n = 7), Peptoniphilus harei (n = 4), Peptoniphilus indolicus (n = 1), Peptoniphilus ivorii (n = 1), Peptoniphilus lacrimalis (n = 1), Anaerococcus prevotii (n = 14), Anaerococcus octavius (n = 1), Anaerococcus tetradius (n = 9), Anaerococcus vaginalis (n = 7), Gemella morbillorum (n = 3), Ruminococcus productus (n = 1), and anaerobic gram-positive cocci (n = 13).

    • ↵ h Eubacterium lentum (n = 1), Eubacterium limosum (n = 1), Eubacterium nodatum (n = 1), Eubacterium saburreum (n = 1), Eubacterium spp. (n = 13), Propionibacterium acnes (n = 19) Propionibacterium sp. (n = 1), Actinomyces meyeri (n = 1), Actinomyces odontolyticus (n = 1), Actinomyces turicensis (n = 1), Arcanobacterium pyogenes (n = 1), Corynebacterium CDC group G-like (anaerobic) (n = 2), Lactobacillus brevis (n = 1), Lactobacillus casei (n = 1), Lactobacillus plantarum (n = 2), Lactobacillus uli (n = 1), and an unusual gram-positive bacillus (n = 1).

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Bacteriology of Moderate-to-Severe Diabetic Foot Infections and In Vitro Activity of Antimicrobial Agents
Diane M. Citron, Ellie J. C. Goldstein, C. Vreni Merriam, Benjamin A. Lipsky, Murray A. Abramson
Journal of Clinical Microbiology Sep 2007, 45 (9) 2819-2828; DOI: 10.1128/JCM.00551-07

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Bacteriology of Moderate-to-Severe Diabetic Foot Infections and In Vitro Activity of Antimicrobial Agents
Diane M. Citron, Ellie J. C. Goldstein, C. Vreni Merriam, Benjamin A. Lipsky, Murray A. Abramson
Journal of Clinical Microbiology Sep 2007, 45 (9) 2819-2828; DOI: 10.1128/JCM.00551-07
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KEYWORDS

Anti-Infective Agents
Bacteria, Aerobic
Bacteria, Anaerobic
Diabetic Foot

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