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Beitragstitel Are “skin commensals” as virulent as “pathogens” in surgically-debrided diabetic foot infections?
Beitragscode P56
Autoren
  1. Karim Gariani Geneva University Hospitals, HUG
  2. Benjamin Kressmann Geneva University Hospitals, HUG
  3. Benjamin Lipsky University of Seattle
  4. Ilker Uçkay Universitätsklinik Balgrist Vortragender
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Introduction
Multiple factors play a role in the multidisciplinary management of diabetic foot infections (DFI), including osteomyelitis (DFO). We investigated if the clinically presumed virulence of intraoperative pathogens is associated with success of combined medical & surgical treatment.

Methods
In this retrospective, single-center (Geneva University Hospitals), cohort evaluation with a follow-up of one year, we divided the microorganisms isolated intraoperatively from DFIs into 2 groups: only skin commensals (coagulase-negative staphylococci, micrococci, cornynebacteria, cutibacteria); and control (at least one aerobic, pyogenic pathogen).

Results
Among 1018 DFI episodes (73%% males, 392 [39%] with DFO cases; 610 [60%] with peripheral arterial disease), the treating clinicians identified skin commensals as the sole causative pathogens (without accompanying pyogenic pathogens) in 54 cases (5%). Cultures from the control (pyogenic pathogen) group involved Staphylococcus aureus (389 cases [38%]), Pseudomonas aeruginosa (61 cases [6%]) and 30 other bacteria generally considered pathogens (e.g., hemolytic-streptococci, or Klebsiella spp).

After treatment (wound debridement in all, partial amputations in 596 [58%], antibiotic therapy [median of 20 days], hyperbaric oxygen therapy in 98 [10%]), 251 episodes (25%) were clinical failures after a median follow-up of six months.

A crude group comparison between only skin commensals and control (some pyogenic pathogen), found no difference in rates of clinical failure (17% vs 24 %, p=0.23) or microbiological recurrence (11% vs 17 %, p=0.23). The number of surgical debridements, proportion of DFO cases, and mean duration of antibiotic therapy (including percent parenteral) were similar.

In multivariate logistic regression analysis with the outcome "clinical failure", culturing only skin commensals from the wound was not a determinant as an independent variable (odds ratio 0.4, 95% confidence interval 0.1-3.8).

Conclusion
DFIs and DFOs from which only skin commensals were isolated were not associated with different clinical or microbiological outcomes from those from which pyogenic pathogens were isolated. Thus, the isolation of only commensals (of presumed low virulence), does not appear to play an important role in the therapeutic outcomes of DFI (including DFO). T