Microbial etiology in diabetic and non diabetic lower extremities ulcers (Spanish text).

摘要

Diabetes is one of the most important public health problems worldwide. Incidence and prevalence of diabetes continue to increase like its chronic complications. An estimated 300 million individuals will have the disease by the year 2025.; There are several well-accepted predisposing factors that place patients with diabetes at high risk for a lower extremity amputation. The most common include peripheral neuropathy, ulceration, infection and vascular disease. Ulceration is the single precursor to amputation in 85% of them.; This study evaluated the underlying pathophysiology, causes, microbiology and current management concepts in diabetic and non diabetic patients and in early and late amputations.; A group of 200, 110 diabetic and 90 non diabetic, patients at the "Puerta del Mar" University hospital in Cadiz, Spain, were included.; All of them had clinically diagnosed infected foot ulcers both neuropathic and ischemic. No patients included were hospitalized or were under current antibiotic treatment for at least four weeks prior to an ulcer culture collection.; The methods of obtaining the specimen to isolate pathogens were punction-aspiration and superficial swab of the ulcer the first and seven day in hospital. The choice of an empirical treatment of the ulcer was based and modified on many factors: microbial etiology, severity of infection, vascular disease and the clinical manifestations.; Diabetic lower extremity ulcers involved deep tissue, extensive purulent drainage and cellulitis (Wagner III, IV and V). Signs of systemic infection like chills and fever were more frequent in the diabetic group too. Most of them were in the forefoot and midfoot in relation to an inadequate shoe.; Several systemic and local factors predicted failure of conservative treatment and early amputation: deep abscess, extensive soft tissue infection, leucocytosis and hyperfibrinogen.; Most often infections of the diabetic foot are polymicrobial. The type of organism present was gram-positive cocci and/or gram negative rods and anaerobes. Staphylococcus aureus and Pseudomonas aeruginosa was the most common infecting agent.; Empiric therapy in our hospital results in a failure because of microbial resistence. The elective treatment should be: for mild-moderate infections, VO cloxacillin or amoxicillin-clavulanic acid and for severe infections, IV antibiotics imipenem or piperacillin-tazobactam.