title: Microbial profile of diabetic foot infections in Trinidad and Tobago.
abstract: OBJECTIVE
  To examine the microbiologic profile of diabetic foot infections in order to guide empiric antibiotic choices.
  
  
  METHODS
  All patients with moderate-severe diabetic foot infections at a tertiary care facility were identified from July 2011 to June 2012. Culture samples were routinely collected before empiric antibiotics were commenced. Retrospective chart review was performed to extract the following data: demographics, clinical details, empiric antibiotic choice and microbiologic data. Descriptive analyses were performed using SPSS 12.0.
  
  
  RESULTS
  There were 139 patients at a mean age of 56.9 ± 12.4 years. Mixed poly-microbial infections were present in 56.8% of cases. Of 221 organisms isolated, 64.7% were gram-negative aerobes, 32.1% were gram-positive aerobes and 3.2% were obligate anaerobes. Multidrug resistant organisms were encountered in 25.9% of cases and included ESBL producers (11.3%), MRSA (4.5%) and VRE (1.4%). Both ciprofloxacin and ceftazidime had good overall anti-microbial activity against gram-negative (68% and 62%, respectively) and gram-positive pathogens (69% and 48%, respectively). Obligate anaerobes were uncommonly isolated due to institutional constraints.
  
  
  CONCLUSIONS
  In this environment, both ciprofloxacin and ceftazidime provide good broad-spectrum anti-microbial activity against the commonly isolated pathogens. Either agent can be used as single agent empiric therapy in patients with moderate/severe diabetic infections in our setting. Although institutional limitations precluded isolation of anaerobes in most cases, there is sufficient evidence for anti-anaerobic agents to be recommended as a part of empiric therapy.
authors.affiliation: Department of Surgery, San Fernando General Hospital, Trinidad and Tobago.
authors.forename: Shariful
authors.initials: S
authors.lastname: Islam
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.forename: Steve
authors.initials: S
authors.lastname: Budhooram
authors.forename: Patrick
authors.initials: P
authors.lastname: Harnarayan
authors.forename: Vijai
authors.initials: V
authors.lastname: Mahabir
authors.forename: Shivaa
authors.initials: S
authors.lastname: Ramsewak
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002442:Ceftazidime / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D017719:Diabetic Foot / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014300:Trinidad and Tobago / Q000453:epidemiology; D014946:Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002442:Ceftazidime
keywords: Amputation; Antibiotics; Culture; Diabetes; Foot infection