title: Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot.
abstract: Infectious complications of the diabetic foot may be influenced by impaired renal function and by immunosuppression therapy.
  
  
  OBJECTIVE
  To assess differences in microbial findings and resistance to antibiotics between transplant recipients, hemodialysis patients, and other patients with the diabetic foot.
  
  
  METHODS
  207 patients treated in the foot clinic for diabetic ulcers from 12/1998 to 12/1999 were included into this retrospective study. Patients were divided into three groups (transplant, dialysis, and other patients). Occurrence of individual bacterial species and resistance to antibiotics was compared between study groups.
  
  
  RESULTS
  Study groups did not differ significantly in ulcer grades defined by the Wagner classification or in the mean number of pathogens per patient. The prevalence of individual microorganisms did not differ between the study groups. However, the study groups differed significantly in the occurrence of microbial resistance to antibiotics. Transplant patients had more frequently Staphylococcus aureus resistant to oxacillin (P<.01), imipenem (P<.01), co-trimoxazole (P<.01), Enterococcus species resistant to ampicillin (P<.01), piperacillin (P<.01), and dialysis patients had more frequently Pseudomonas species resistant to piperacillin (P<.05) and cefpirom (P<.05) in comparison with the other two groups.
  
  
  CONCLUSIONS
  Transplant patients had significantly more resistant microorganisms in comparison with dialysis and other patients with the diabetic foot. Empiric antibiotic selection based on general population data should be modified in transplant patients with diabetic foot according to actual susceptibility to antibacterial drugs.
authors.affiliation: Diabetes Center, Institute for Clinical and Experimental Medicine, Vídeñská 1958/9, Prague, 140 21, Czech Republic. vlfe@medicon.cz
authors.forename: Vladimíra
authors.initials: V
authors.lastname: Fejfarová
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jirkovská
authors.forename: Vladimír
authors.initials: V
authors.lastname: Petkov
authors.forename: Petr
authors.initials: P
authors.lastname: Boucek
authors.forename: Jelena
authors.initials: J
authors.lastname: Skibová
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects; D001424:Bacterial Infections / Q000453:epidemiology*; D017719:Diabetic Foot / Q000382:microbiology / Q000503:physiopathology*; D024881:Drug Resistance, Bacterial; D015994:Incidence; D016030:Kidney Transplantation; D008826:Microbial Sensitivity Tests; D010045:Outpatients; D006435:Renal Dialysis
chemical_list: D000900:Anti-Bacterial Agents