Novosti
Khirurgii
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Научно-практическая конференция с международным участием и
XXVIII Пленум Правления Белорусской ассоциации хирургов
«Актуальные вопросы и современные подходы в оказании
хирургической помощи в Республике Беларусь»
18-19 ноября 2021 года в г. Минск.






Year 2015 Vol. 23 No 1

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2015.1.70   |  

S.D. SHAPOVAL, I.L. SAVON, A.N. YAKUNICH, O.O. MAKSIMOVA

RESISTANT AND MULTIRESISTANT AGENTS OF PYONECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine",
Ukraine

Objectives. To study the microbiological profile and antimicrobial resistance in patients with complicated diabetic foot syndrome (DFS).
Methods. The study involved 174 patients with DFS within 2013-2014 yrs. All patients with diabetes mellitus (DM) II type (average duration 12,8±2,9 years). The average age of the patients was 59,3±5,3 years. The pyo-necrotic injuries of foot – abscess, phlegmon, pyogenic abscess, pyogenic tendovaginitis, pyogenic arthritis, gangrene have been diagnosed in the patients. According to the PEDIS classification the process had P1-2E1-2D2-3I2-3S1-2 characteristics. Determination of the qualitative composition of flora and sensitivity to antibiotics of isolated cultures was performed with the automatic bacteriological analyzer (Vitek 2 Compact – France).
Results. The cause of pyo-necrotic complications of DFS were gram-positive flora in 56,9% of cases, in 33,3% – gram-negative, in 2,9% – anaerobes, in 2,3% – fungi. The phenomenon of resistance to the major antimicrobial drugs was revealed in 65 (37,4%) bacteria. Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Esherihia coli, Acinetobacter baumannii, Enterococcus faecalis had the greatest resistance. Among the groups with the identified Pseudomonas aeruginosa, 66,0% of the bacteria were characterized by a phenotype of resistance to carbapenems, 33,0% of which were panresistant ones. In patients with Staphylococcus aureus in 60,5% of cases the gene of MRSA with three genetic variations differed by resistance to certain groups of antibiotics was revealed. The most important was panresistant one (4,3%).
Conclusion. The antibiotic therapy ineffectiveness in patients with DFS is caused by a large number of resistant and panresistant forms. Active drugs against MRSA are daptomycin, vancomycin, teicoplanin, tigecycline. In case of infections caused by ESBL-producing bacteria the use of carbapenems (imipenem / cilastatin and meropenem) remains topical. Reserve tigecycline for use in situations when alternative treatments not suitable.

Keywords: diabetic foot, resistant bacteria, antibiotic therapy, MRSA, ESBL
p. 70-76 of the original issue
References
  1. Gilbert DN, Mellering RK, Eliopulos DM. / red. Spasokukotskii A.L. Spravochnik Senforda po protivomikrobnoi terapii [The Sanford Guide to Antimicrobial Therapy]. Kiev, Ukraina: Ukr Med Vestn; 2012. 272 p.
  2. Crouzet J, Lavigne JP, Richard JL, Sotto A. Diabetic foot infection: a critical review of recent randomized clinical trials on antibiotic therapy. Int J Infect Dis. 2011 Sep;15(9):e601-10.
  3. Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. 2009 Nov 15;49(10):1541-49.
  4. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, et. Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55.
  5. Iakovlev SV, Iakovlev VP. Sovremennaia antimikrobnaia terapiia v tablitsakh [Modern antimicrobial therapy in the tables]. Consilium Medicum. 2009;4(11):2-82.
  6. Salmanov AG, Marievskii VF. Antibiotikorezistentnost' nozokomial'nykh shtammov Staphylococcus aureus v Ukraine: rezul'taty mnogotsentrovogo issledovaniia [Antibiotic resistance of nosocomial Staphylococcus aureus strains in Ukraine: results of a multicenter study]. Novosti Khirurgii. 2013;21(4):78-83.
  7. Gardner SE, Hillis SL, Frantz RA. Clinical signs of infection in diabetic foot ulcers with high microbial load. Biol Res Nurs. 2009 Oct;11(2):119-28.
  8. Richard JL, Lavigne JP, Got I, Hartemann A, Malgrange D, Tsirtsikolou D, Baleydier A, Senneville E. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. 2011 Jun;37(3):208-15.
  9. Aragуn-Sбnchez J.Seminar review: A review of the basis of surgical treatment of diabetic foot infections. Int J Low Extrem Wounds. 2011 Mar;10(1):33-65.
  10. Fincke BG, Miller DR, Christiansen CL, Turpin RS. Variation in antibiotic treatment for diabetic patients with serious foot infections: a retrospective observational study. BMC Health Serv Res. 2010 Jul 6;10:193.
  11. International Working Group on the Diabetic Foot. International consensus on the diabetic foot [CD-ROM]. Brussels: International Diabetes Foundation, May, 2003.
Address for correspondence:
69096, Ukraina, g. Zaporozhe,
bul. Vintera, d. 20,
GZ "Zaporozhskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya MZ Ukrainyi" ,
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gnoyno-septicheskoy khirurgii i ultrazvukovoy diagnostiki,
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t.mob.: 38-050-577-16-47,
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Shapoval Sergey Dmitrievich
Information about the authors:
Shapoval S.D. MD, professor, first Vice-rector, a head of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Savon I.L. MD, an associate professor of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Yakunich A.N. PhD, an assistant of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Maksimova O.O. PhD, assistant of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
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