BACTERIAL SPECIES AND ANTIMICROBIAL SUSCEPTIBILITY OF WOUND CULTURE OBTAINED FROM DIABETIC GANGRENE PATIENTS WHO UNDERWENT LIMB AMPUTATION AT A JAPANESE UNIVERSITY HOSPITAL

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  • YAMAGUCHI Hayato
    Department of Laboratory Medicine, Showa University Northern Yokohama Hospital Infection Control Unit, Showa University Northern Yokohama Hospital Central Clinical Laboratory, Showa University Northern Yokohama Hospital
  • FUKUOKA Seiji
    Infection Control Unit, Showa University Northern Yokohama Hospital Central Clinical Laboratory, Showa University Northern Yokohama Hospital
  • NAKAMURA Masanori
    Department of Orthopedics, Showa University Northern Yokohama Hospital
  • EBARA Tetsu
    Department of Internal Medicine, Showa University Northern Yokohama Hospital
  • KIMURA Satoshi
    Department of Laboratory Medicine, Showa University Northern Yokohama Hospital Infection Control Unit, Showa University Northern Yokohama Hospital Central Clinical Laboratory, Showa University Northern Yokohama Hospital

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  • 糖尿病性壊疽による四肢切断症例での患部検出菌と抗菌薬の感受性
  • トウニョウビョウセイ エソ ニ ヨル シシ セツダン ショウレイ デ ノ カンブ ケンシュツキン ト コウキンヤク ノ カンジュセイ

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Abstract

The number of patients with diabetic gangrene is increasing. Antimicrobial treatment is commonly used, however, limb amputation is unavoidable in the severe cases. For prophylaxis at operation, basic antimicrobial agents such as cefazolin are often administrated, however, severe infection could occur if resistant strains were cultured especially in immunosuppressive patients such as in those with diabetes. The purpose of this study was to clarify bacterial species and their susceptibility to antimicrobial agents for patients with diabetic foot gangrene. Twenty-four patients (nine females) who underwent amputation of their legs for the treatment of diabetic gangrene were enrolled from year 2002 to 2012. Among them, fifteen patients had diabetic history for over ten years, and eleven patients had repetitive hemodialysis. The patients were age from 40-81 (mean 67), with an average hospitalization period of 81.6 days. As a result, fifty-seven strains were isolated. Among them, 62% strains were Gram-positive cocci, 33% were Gram-negative rods, 5% were Gram-positive rods. Two or more strains were detected in fifteen patients. Indigenous bacteria of skin such as MSSA were most commonly cultured (n = 10). MRSA was found in only one patient. Regarding resistance, 67% of Peptostreptococci (n = 7), and 75% of E.coli (n = 4) were resistant to new quinolones. All Enterococci (n = 6) were susceptible to penicillin. As a result, 70% of the operated patients had no complications and were discharged normally. Others underwent re-operation, including two cases who died due to heart disease. The most commonly used antimicrobial agent for prophylaxis was cefazolin (n = 8). However, 60% of all operated cases had a resistant bacterial strain against cefazolin. We conclude that in order to avoid inappropriate antimicrobial therapy, it is important to confirm antimicrobial susceptibility with bacterial culture before operation.

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