Journal
DIABETES RESEARCH AND CLINICAL PRACTICE
Volume 84, Issue 2, Pages 187-193Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2009.02.008
Keywords
Ischemic vs. neuropathic foot ulcer; MRSA and MRSE strains; Multidrug resistance
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We examined whether foot ischemia or neuropathy with diabetic foot ulcer (DFU) promote selection of staphylococci species, evaluated frequency of MRSA and MRSE among strains yielded from patients with DFU and assessed multidrug resistance of isolates. Patients with DFU and foot osteomyelitis were divided into ischemic foot ulcer (IFU, n = 21) and neuropathic foot ulcer (NFU, n = 29) groups. Frequency of Staphylococcus epidermidis yielded from curettage of IFU was higher compared with NFU (P < 0.05). S. epidermidis was also more frequently isolated from the toe web surface of patients with IFU compared with NFU (55% vs. 17.9%, respectively) and healthy volunteers (HV, n = 20) (17.6%, P < 0.05). These mostly MRSE strains (83.3-100%) originating from DFU patients were multidrug resistant (88.8%). Also, most of MRSA isolates were multidrug resistant (70.3%). Higher rates of MSSA from DFU patients than HV showed resistance to antimicrobials. This is the first report indicating that diabetic patients with IFU differ with NFU patients in higher frequency of S. epidermidis skin colonization and ulcer infection. We suggest that IFU should be defined as separate disease state of DFU and S. epidermidis should be appreciated as a nosocomial pathogen. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
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