Methicillin-resistant Staphylococcus aureus in diabetic foot infections.
Diabetic foot ulcers are often complicated by infection. Among pathogens, Staphylococcus aureus predominates. The prevalence of methicillin-resistant S. aureus (MRSA) in infected foot ulcers is 15-30% and there is an alarming trend for increase in many countries. There are also data that recognize new strains of MRSA that are resistant to vancomycin. The risk for MRSA isolation increases in the presence of osteomyelitis, nasal carriage of MRSA, prior use of antibacterials or hospitalization, larger ulcer size and longer duration of the ulcer. The need for amputation and surgical debridement increases in patients infected with MRSA. Infections of mild or moderate severity caused by community-acquired MRSA can be treated with cotrimoxazole (trimethoprim/sulfamethoxazole), doxycycline or clindamycin when susceptibility results are available, while severe community-acquired or hospital-acquired MRSA infections should be managed with glycopeptides, linezolide or daptomycin. Dalbavancin, tigecycline and ceftobiprole are newer promising antimicrobial agents active against MRSA that may also have a role in the treatment of foot infections if more data on their efficacy and safety become available.
Eleftheriadou
Ioanna
I
Department of Propaedeutic and Internal Medicine, Athens University Medical School, Greece.
Tentolouris
Nicholas
N
Argiana
Vasiliki
V
Jude
Edward
E
Boulton
Andrew J
AJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D017719:Diabetic Foot / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D006020:Glycopeptides / Q000627:therapeutic use; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D011500:Protein Synthesis Inhibitors / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D006020:Glycopeptides; D011500:Protein Synthesis Inhibitors