RESUMO
BACKGROUND: The microbiology of the diabetic foot is complex, making swab culture controversial; biopsy culture is the gold standard. OBJECTIVE: To determine the diagnostic utility of swab culture in diabetic foot ulcers. METHODS: Comparative study of diagnostic utility. Diabetic foot ulcers were classified according to the University of Texas scale. Cultures by biopsy and swabbing were performed. Bacterial identification was performed by standard biochemical methods. Antimicrobial susceptibility was determined by the plate diffusion method. An analysis of the diagnostic test was made, reporting descriptive measures of frequencies. RESULTS: We obtained specimens for culture from 118 patients. Grade II and III lesions were the most frequently occurring (80%). Overall, 132 organisms were isolated from biopsies and 118 from swabs, with those of the Enterobacteriaceae family being the most frequent (56% from biopsies and 60% from swabs). Swab culture had a calculated sensitivity of 0.85, specificity of 0.86, positive predictive value of 0.98, negative predictive value of 0.43, positive likelihood ratio of 5.9, and negative likelihood ratio of 0.2. CONCLUSION: Swab culture is a reasonable option to determine the diabetic foot microbiology.
Assuntos
Técnicas Bacteriológicas/métodos , Pé Diabético/microbiologia , Biópsia , Pé Diabético/patologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/métodos , Feminino , Pé/microbiologia , Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
There is a fatalist perception of diabetic foot because the argument of "small-vessel disease" prevails. This is the report of a cohort study of patients facing a formal recommendation for major foot amputation to assess how many can be saved with a conventional treatment, defined as debridement, pressure alleviation, metabolic control, and antibiotics. The primary efficacy measurement was the salvage of the limb at the follow-up visit between 25 and 35 days after the first consultation. The secondary efficacy measurement was the subsequent epithelization of the ulcerative lesions, following patients for up to 270 days. The cohort consisted of 105 type 2 diabetic patients; 87 (83%) had severe lesions. A total of 71 patients (68%) required hospitalization. By the intention-to-treat analysis, 89 patients (85%) avoided major amputation. A total of 88 patients were evaluated for complete epithelization, reaching median success by day 120. Overall, 51 patients (49%) underwent minor amputations. It was concluded that there is a high rate of unnecessary major foot amputations, because a diabetic foot can be salvaged across the continuum of severity when patients receive care in a multidisciplinary wound clinic.
Assuntos
Pé Diabético/terapia , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica/estatística & dados numéricos , Antibacterianos/uso terapêutico , Estudos de Coortes , Desbridamento , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To determine the microbiology of diabetic foot wounds, through biopsy cultures. MATERIALS AND METHODS: Patients with diabetic foot and clinical data of infection were recruited consecutively. Cultures were processed for aerobic organisms after mortar homogenization. For cases with multiple isolates, only the two predominant organisms were identified. The bacterial identification was carried out by biochemical procedures. The sensitivity to antibiotics was made by the disk diffusion method. RESULTS: A total of 91 biopsies were studied, 47 from men (52%). There were 102 isolates, 68 being Gram-negative bacilli (67%), with predominance of Escherichia coli (21%). A total of 28 Gram-positive cocci were isolated (28%) and 6 yeasts (6%). Of the 68 Gram-negative bacilli, 24 were resistant to ciprofloxacin (35%). A total of 55 Enterobacteriaceae were isolated, of which 4 (7%) produced extended-spectrum beta-lactamases. There were 8 Staphylococcus aureus isolates, 3 of which (38%) were resistant to methicillin. CONCLUSIONS: In comparison with reports from industrialized countries, we found a higher proportion of Gram-negative and resistant organisms.