Antibiotic combinations in polymicrobic diabetic foot infections.
OBJECTIVE
The aim of this study was to evaluate synergistic potential of antibiotic combinations against pathogenic microorganisms isolated from patients with diabetic foot wounds.


METHODS
272 diabetic foot patients were studied prospectively over a two-year period. Tissue curettage samples from ulcer base were processed microbiologically to isolate aerobic as well as anaerobic pathogens. [775 isolates] Antibiotic susceptibility testing [MIC/MBC], from amongst these organisms revealed 75 multiresistant organisms, of which only 69 strains could be further studied to assess synergistic effect of various antibiotic combinations by the microtitre checkerboard assay technique.


RESULTS
The checkerboard synergy studies showed that overall, synergy could be demonstrated in 21.74% to 59.57%. Amongst the 14 combinations tested, it was found that four combinations could be of worthwhile clinical significance, namely Amikacin/Piperacillin [AK + PP] [77.50%]; Ampicillin-Sulbactum/Piperacillin [AS + PP] [76.92%]; Ampicillin Sulbactum/Cefoperazone [AS + CP] [74.47%], and Ofloxacillin/Cefotaxime [OF + CT] [71.43%].


CONCLUSIONS
Amikacin/Piperacillin is a combination that has been proven to be of synergistic potential. This study not only confirms this observation but also showed that Ampitum-Sulbactum in combination with either Piperacillin or Cefoperazone was equally efficacious. Furthermore, it was also observed that Ofloxacillin/Cefotaxime combination could be almost equally useful. The study thus emphasizes that antibiotic combinations which are synergistic can be of great clinical significance in the management of patients with diabetic foot infections.
Pathare
N A
NA
All India Institute of Diabetes, S.L. Raheja Hospital, Mahim, Mumbai-400 016.
Sathe
S R
SR
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D017719:Diabetic Foot / Q000188:drug therapy* / Q000382:microbiology; D004357:Drug Synergism; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies
D000900:Anti-Bacterial Agents