Microbial composition of purulent lesions in patients with complicated diabetic foot syndrome and the development of sepsis
Background. Bacterial infection is a major pathogenetic factor in the formation of diabetic foot complications. Concomitant infection is the cause of amputations of the lower limbs in 25–72 % of cases, especially when diabetic foot syndrome is complicated by sepsis. The aim of our study was to identify differences in the microbial landscape of purulent foci in patients with diabetic foot syndrome complicated by sepsis and for the further development of the algorithm of directed antibiotic therapy. Materials and methods. A total of 724 patients were observed in the dynamics of complicated diabetic foot syndrome, including 71 patients with the disease complicated by sepsis. Accordingly, the patients were divided into two groups: group 1 consisted of patients with complicated diabetic foot syndrome — 653 individuals (90.2 %), and group 2 included patients with symptoms of sepsis — 71 (9.8 %). The complex of bacteriological studies consisted of determining the sensitivity of microorganisms to antibiotics, the qualitative composition of microbial pathogens and the number of microbial cells per 1 g of tissues. To determine the sensitivity of microorganisms in the suppurative focus to antibiotics, we have used rapid method by S.D. Shapoval (2005), and in recent years — automated Vitek-2 system. Results. The analyzed data indicate that in patients with complicated diabetic foot syndrome, the number of microbial cells in 1 g of tissue in the center of infection did not exceed 105–106, while in more than 50 % of patients with sepsis, this figure was 107–1012. Isolation of aerobic monoinfection from purulent foci in patients with complicated diabetic foot syndrome in the period from 2006 to 2016 decreased from 48.7 to 39.2 % (P < 0.005). There is an increase in the isolation of Gram-positive microorganisms from 53.2 to 66.2 % (P < 0.005). The dynamics of microbiological researches indicates an increase in the proportion of Methicillin-resistant Staphylococcus aureus from 23.4 to 43.3 %. Isolation of aerobic monoinfection in septic patients also decreased from 37.5 % in 2006 to 31.6 % in 2016, but the balance of Gram-positive and Gram-negative organisms is maintained. The number of microbial associations, which are derived from a purulent focus, increased from 46.2 to 56.6 % in patients with complicated diabetic foot syndrome and from 56.2 to 68.4 % — in patients with sepsis (P < 0.005). Isolated microbial pathogens are characterized by a high level of antibiotic resistance, especially to the first-second generation antibiotics. Conclusions. These experiments made it possible to distinguish the features of microbial landscape in purulent foci of the two groups of patients and to determine the algorithm of antibiotic therapy.
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