title: Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence.
abstract: A retrospective case-control study of 118 (male : female, 68 : 50) Chinese type 2 diabetic patients with foot ulcers (Wagner's grade 3-5) was conducted to determine the prevalence and risk factors for meticillin-resistant Staphylococcus aureus (MRSA) infection in relation to the original community or hospital parameters. Ulcer specimens were processed for Gram staining, aerobic culture and antimicrobial susceptibility testing. Staphylococcus species were tested for meticillin resistance using oxacillin. S. aureus was the most frequent pathogen (25.6 %) in diabetic patient specimens (160 isolates), and a high proportion of S. aureus isolates were MRSA (63.4 %). A high percentage of S. aureus isolates (65.4 %) satisfied the definition for hospital-associated MRSA (HA-MRSA) infection. The size of ulcers [adjusted odds ratio (OR) 1.61; 95 % confidence interval (CI) 1.22-2.12] and osteomyelitis (adjusted OR 18.51, 95 % CI 2.50-137.21) were independent predictors of MRSA infection. The HA-MRSA group had a significantly different distribution from the community-associated MRSA group with respect to age, history of diabetes and length of hospital stay (all P<0.001). Neuropathy, vascular disease (all P=0.049) and osteomyelitis (P=0.026) were the most common underlying conditions observed in the HA-MRSA group. This study contributes to the establishment of precautions against the emergence of MRSA including MRSA acquired from different sources among the Chinese population with diabetic foot ulcers based on their original or clinical parameters.
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Zi-Lin
authors.initials: ZL
authors.lastname: Sun
authors.affiliation: Department of Neurology and Institution of Cerebral Vascular Disease, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Guo
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Bing-Quan
authors.initials: BQ
authors.lastname: Yang
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Qiong
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, Nanjing 210009, PR China.
authors.forename: Kuan-Ping
authors.initials: KP
authors.lastname: Ye
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002681:China; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D048909:Diabetes Complications / Q000382:microbiology* / Q000473:pathology; D005260:Female; D016523:Foot Ulcer / Q000382:microbiology* / Q000473:pathology; D006761:Hospitals; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology