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Microbiological Concordance in the Management of Diabetic Foot Ulcer Infections with Osteomyelitis, on the Basis of Cultures of Different Specimens at a Diabetic Foot Center in China

Authors Li X, Cheng Q, Du Z, Zhu S, Cheng C

Received 9 December 2020

Accepted for publication 11 March 2021

Published 6 April 2021 Volume 2021:14 Pages 1493—1503

DOI https://doi.org/10.2147/DMSO.S296484

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Antonio Brunetti


Xuemei Li,1,2 Qingfeng Cheng,3 Zhipeng Du,3 Shenyin Zhu,2 Chao Cheng4

1Department of Pharmacy, Chongqing Health Center for Women and Children, Chongqing, People’s Republic of China; 2Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei, People’s Republic of China

Correspondence: Chao Cheng
Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136, Jingzhou Street, Xiangcheng District, Hubei, 441021, People’s Republic of China
Tel +86 23 8901 2401
Fax +86 23 68811793
Email [email protected]
Shenyin Zhu
Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, People’s Republic of China
Tel +86 23 8901 2401 Fax +86 23 68811793 Email [email protected]

Objective: This study aimed to assess the microbiological concordance between swab and soft tissue cultures, and corresponding bone specimen cultures from patients with diabetic foot osteomyelitis (DFO). We aimed to analyze the bone specimens’ antimicrobial susceptibilities, and to improve clinical management of diabetic foot ulcer infections by using proper antibiotics.
Methods: The microbial culture results of ulcer swabs, and soft tissue and bone tissue specimens, and the antimicrobial susceptibility tests of bone specimens from patients with DFO were analyzed in a single diabetic foot center.
Results: A total of 60 patients with results from three specimens were included. Staphylococcus aureus was the most common bacterium isolated from the three specimens. The microbiological results for the three specimens were identical in 12 cases, the culture results from swabs and bone tissue specimens were identical in 14 cases, and the results from soft tissue and bone tissue were identical in 46 cases. The concordance of the results of pathogens isolated between soft tissue and bone specimen cultures was higher than that between the swab and bone cultures. Gram-positive bacteria were more sensitive to moxifloxacin, linezolid, and vancomycin, while Gram-negative bacteria were more sensitive to piperacillin/tazobactam, cefoperazone/sulbactam, and carbapenems.
Conclusion: Soft tissue culture results have more reliable microbiological concordance to identify DFO bacteria than swab culture results and targeted antibiotic therapy for DFO should be based on antimicrobial susceptibility testing in bone tissue specimen cultures.

Keywords: diabetic foot osteomyelitis, ulcer swabbing, microbiological concordance, antimicrobial susceptibility test, targeted antibiotic therapy

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