• 1

    Rice JB, Desai U, Cummings AK, et al: Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care 37: 651, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 2

    Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al: The global burden of diabetic foot disease. Lancet 366: 1719, 2005.

  • 3

    Reiber GE, Lipsky BA, Gibbons GW: The burden of diabetic foot ulcers. Am J Surg 176(suppl): 5S, 1998.

  • 4

    Richard JL, Lavigne JP, Got I, et al: Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. Diabetes Metab 37: 208, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5

    Uccioli L, Gandini R, Giurato L, et al: Long-term outcomes of diabetic patients with critical limb ischemia followed in a tertiary referral diabetic foot clinic. Diabetes Care 33: 977, 2010.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 6

    Moulik PK, Mtonga R, Gill GV: Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 26: 491, 2003.

  • 7

    Prompers L, Schaper N, Apelqvist J, et al: Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 51: 747, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    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: 132, 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Caputo GM, Cavanagh PR, Ulbrecht JS, et al: Assessment and management of foot disease in patients with diabetes. N Engl J Med 331: 854, 1994.

  • 10

    Pittet D, Wyssa B, Herter-Clavel C, et al: Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up. Arch Intern Med 159: 851, 1999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Lipsky BA, Berendt AR, Deery HG, et al: Diagnosis and treatment of diabetic foot infections. Plast Reconstr Surg 117(suppl): 212S, 2006.

  • 12

    Williams DT, Hilton JR, Harding KG: Diagnosing foot infection in diabetes. Clin Infect Dis 39: 83, 2004.

  • 13

    Michalia M, Kompoti M, Koutsikou A, et al: Diabetes mellitus is an independent risk factor for ICU-acquired bloodstream infections. Intensive Care Med 35: 448, 2009.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 14

    McKane CK, Marmarelis M, Mendu ML, et al: Diabetes mellitus and community-acquired bloodstream infections in the critically ill. J Crit Care 29: 70, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15

    Chu VH, Cabell CH, Benjamin DK, et al: Early predictors of in-hospital death in infective endocarditis. Circulation 109: 1745, 2004.

  • 16

    Strom BL, Abrutyn E, Berlin JA, et al: Risk factors for infective endocarditis: oral hygiene and nondental exposures. Circulation 102: 2842, 2000.

  • 17

    Cooper G, Platt R: Staphylococcus aureus bacteremia in diabetic patients. Am J Med 73: 658, 1982.

  • 18

    Chen SY, Giurini JM, Karchmer AW: Invasive systemic infection after hospital treatment for diabetic foot ulcer: risk of occurrence and effect on survival. Clin Infect Dis 64: 326, 2017.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 19

    Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 132: 1435, 2015.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 20

    Roghmann MC, Siddiqui A, Plaisance K, et al: MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 47: 98, 2001.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Huang SS, Hinrichsen VL, Datta R, et al: Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection. PloS One 6: e24340, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation

Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer

Understanding and Mitigating the Risk

Andrew J. Hale University of Vermont Medical Center and Larner College of Medicine, University of Vermont, Burlington, VT.

Search for other papers by Andrew J. Hale in
Current site
Google Scholar
PubMed
Close
 MD
,
Emily Vicks Middlebury College, Middlebury, VT.

Search for other papers by Emily Vicks in
Current site
Google Scholar
PubMed
Close
 BA
,
Mary T. LaSalvia Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Search for other papers by Mary T. LaSalvia in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
John M. Giurini Division of Podiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Search for other papers by John M. Giurini in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Adolf W. Karchmer Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Search for other papers by Adolf W. Karchmer in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.

Corresponding author: Andrew J. Hale, MD, 111 Colchester Ave, Main Campus, East Pavilion, Level 5, Burlington, VT 05401. (E-mail: andrew.hale@uvmhealth.org)