Citron DM, Goldstein EJ, Merriam CV, et al: Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 45: 2819, 2007.
Hatipoglu M, Mutluoglu M, Uzun G, et al: The microbiologic profile of diabetic foot infections in Turkey: a 20-year systematic review: diabetic foot infections in Turkey. Eur J Clin Microbiol Infect Dis 33: 871, 2014.
Lipsky BA, Berendt AR, Cornia PB, et al: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54: e132, 2012.
Lipsky BA, Holroyd KJ, Zasloff M: Topical versus systemic antimicrobial therapy for treating mildly infected diabetic foot ulcers: a randomized, controlled, double-blinded, multicenter trial of pexiganan cream. Clin Infect Dis 47: 1537, 2008.
Hartemann-Heurtier A, Robert J, Jacqueminet S, et al: Diabetic foot ulcer and multidrug-resistant organisms: risk factors and impact. Diabet Med 21: 710, 2004.
Young H, Knepper B, Hernandez W, et al: Pseudomonas aeruginosa: an uncommon cause of diabetic foot infection. JAPMA 105: 125, 2015.
Spichler A, Hurwitz BL, Armstrong DG, et al: Microbiology of diabetic foot infections: from Louis Pasteur to ‘crime scene investigation'. BMC Med 13: 2, 2015.
Al Benwan K, Al Mulla A, Rotimi VO: A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health 5: 1, 2012.
Raja NS: Microbiology of diabetic foot infections in a teaching hospital in Malaysia: a retrospective study of 194 cases. J Microbiol Immunol Infect 40: 39, 2007.
Abdulrazak A, Bitar ZI, Al-Shamali AA, et al: Bacteriological study of diabetic foot infections. J Diabetes Complications 19: 138, 2005.
Ramakant P, Verma AK, Misra R, et al: Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia 54: 58, 2011.
Ertugrul BM, Oncul O, Tulek N, et al: A prospective, multi-center study: factors related to the management of diabetic foot infections. Eur J Clin Microbiol Infect Dis 31: 2345, 2012.
Ertugrul MB, Baktiroglu S, Salman S, et al: Pathogens isolated from deep soft tissue and bone in patients with diabetic foot infections. JAPMA 98: 290, 2008.
Kandemir O, Akbay E, Sahin E, et al: Risk factors for infection of the diabetic foot with multi-antibiotic resistant microorganisms. J Infect 54: 439, 2007.
Turhan V, Mutluoglu M, Acar A, et al: Increasing incidence of Gram-negative organisms in bacterial agents isolated from diabetic foot ulcers. J Infect Dev Ctries 7: 707, 2013.
Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL: Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation. Int J Low Extrem Wounds 12: 63, 2013.
Gellatly SL, Hancock RE: Pseudomonas aeruginosa: new insights into pathogenesis and host defenses. Pathog Dis 67: 159, 2013.
Aloush V, Navon-Venezia S, Seigman-Igra Y, et al: Multidrug-resistant Pseudomonas aeruginosa: risk factors and clinical impact. Antimicrob Agents Chemother 50: 43, 2006.
Gransden WR, Leibovici L, Eykyn SJ, et al: Risk factors and a clinical index for diagnosis of Pseudomonas aeruginosa bacteremia. Clin Microbiol Infect 1: 119, 1995.
Venier AG, Lavigne T, Jarno P, et al: Nosocomial urinary tract infection in the intensive care unit: when should Pseudomonas aeruginosa be suspected? experience of the French national surveillance of nosocomial infections in the intensive care unit, Rea-Raisin. Clin Microbiol Infect 18: E13, 2012.
Selecting empirical therapy for a diabetic foot infection (DFI) requires knowing how likely infection with Pseudomonas aeruginosa is in a particular patient. We designed this study to define the risk factors associated with P aeruginosa in DFI.
We performed a preplanned microbiological subanalysis of data from a study assessing the effects of treatment with intralesional epidermal growth factor for diabetic foot wounds in patients in Turkey between January 1, 2012, and December 31, 2013. Patients were screened for risk factors, and the data of enrolled individuals were recorded in custom-designed patient data forms. Factors affecting P aeruginosa isolation were evaluated by univariate and multivariate logistic regression analyses, with statistical significance set at P < .05.
There were 174 patients enrolled in the main study. Statistical analysis was performed in 90 evaluable patients for whom we had microbiological assessments. Cultures were sterile in 19 patients, and 89 bacterial isolates were found in the other 71. The most frequently isolated bacteria were P aeruginosa (n = 23, 25.8%) and Staphylococcus aureus (n = 12, 13.5%). Previous lower-extremity amputation and a history of using active wound dressings were the only statistically significant independent risk factors for the isolation of P aeruginosa in these DFIs.
This retrospective study provides some information on risk factors for infection with this difficult pathogen in patients with DFI. We need prospective studies in various parts of the world to better define this issue.