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Pseudomonas aeruginosa

An Uncommon Cause of Diabetic Foot Infection

Heather Young Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver, Aurora, CO.

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Bryan Knepper Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO.

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Whitney Hernandez

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Asaf Shor Division of Infectious Diseases, University of Colorado Denver, Aurora, CO.

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Merribeth Bruntz Department of Orthopedic Surgery, Denver Health Medical Center and University of Colorado Denver, Aurora, CO.

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Chrystal Berg Department of Orthopedic Surgery, Denver Health Medical Center and University of Colorado Denver, Aurora, CO.

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Connie S. Price Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver, Aurora, CO.

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Background

Pseudomonas aeruginosa has traditionally been considered a common pathogen in diabetic foot infection (DFI), yet the 2012 Infectious Diseases Society of America guideline for DFI states that “empiric therapy directed at P aeruginosa is usually unnecessary.” The objective of this study was to evaluate the frequency of P aeruginosa isolated from bone or tissue cultures from patients with DFI.

Methods

This study is a cross-sectional survey of diabetic patients presenting with a foot infection to an urban county hospital between July 1, 2012, and December 31, 2013. All of the patients had at least one debridement procedure during which tissue or bone cultures from operative or bedside debridements were obtained. The χ2 test and the t test of means were used to determine relationships between variables and the frequency of P aeruginosa in culture.

Results

The median number of bacteria isolated from DFI was two. Streptococcus spp and Staphylococcus aureus were the most commonly isolated organisms; P aeruginosa was isolated in only five of 112 patients (4.5%). The presence of P aeruginosa was not associated with the patient's age, glycosylated hemoglobin level, tobacco abuse, the presence of osteomyelitis, a prescription for antibiotic drugs in the preceding 3 months, or the type of operative procedure.

Conclusions

Pseudomonas aeruginosa was an infrequent isolate from DFI in this urban, underserved diabetic population. The presence of P aeruginosa was not associated with any measured risk factors. By introducing a clinical practice guideline, we hope to discourage frontline providers from using routine antipseudomonal antibiotic drugs for DFI.

Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.

Corresponding author: Heather Young, MD, Denver Health Medical Center, 660 Bannock St, MC 4000, Denver, CO 80204. (E-mail: Heather.Young2@dhha.org)