title: Epidemiology and prevalence of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in patients with diabetic foot ulcers: focus on the differences between species isolated from individuals with ischemic vs. neuropathic foot ulcers.
abstract: We examined whether foot ischemia or neuropathy with diabetic foot ulcer (DFU) promote selection of staphylococci species, evaluated frequency of MRSA and MRSE among strains yielded from patients with DFU and assessed multidrug resistance of isolates. Patients with DFU and foot osteomyelitis were divided into ischemic foot ulcer (IFU, n=21) and neuropathic foot ulcer (NFU, n=29) groups. Frequency of Staphylococcus epidermidis yielded from curettage of IFU was higher compared with NFU (P<0.05). S. epidermidis was also more frequently isolated from the toe web surface of patients with IFU compared with NFU (55% vs. 17.9%, respectively) and healthy volunteers (HV, n=20) (17.6%, P<0.05). These mostly MRSE strains (83.3-100%) originating from DFU patients were multidrug resistant (88.8%). Also, most of MRSA isolates were multidrug resistant (70.3%). Higher rates of MSSA from DFU patients than HV showed resistance to antimicrobials. This is the first report indicating that diabetic patients with IFU differ with NFU patients in higher frequency of S. epidermidis skin colonization and ulcer infection. We suggest that IFU should be defined as separate disease state of DFU and S. epidermidis should be appreciated as a nosocomial pathogen.
authors.affiliation: Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 02-106 Warsaw, 5 Pawinskiego str, Poland. hgalk@cmdik.pan.pl
authors.forename: Hanna
authors.initials: H
authors.lastname: Galkowska
authors.forename: Adrianna
authors.initials: A
authors.lastname: Podbielska
authors.forename: Waldemar L
authors.initials: WL
authors.lastname: Olszewski
authors.forename: Ewa
authors.initials: E
authors.lastname: Stelmach
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Luczak
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Rosinski
authors.forename: Waldemar
authors.initials: W
authors.lastname: Karnafel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000235:genetics / Q000302:isolation & purification; D003925:Diabetic Angiopathies / Q000382:microbiology; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology*; D003929:Diabetic Neuropathies / Q000382:microbiology; D005260:Female; D016523:Foot Ulcer / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007511:Ischemia / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial