title: [Distribution of pathogens in diabetic foot osteomyelitis and risk factors of osteomyelitis].
abstract: OBJECTIVE
  To explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.
  
  
  METHODS
  A total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.
  
  
  RESULTS
  Gram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).
  
  
  CONCLUSIONS
  In addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.
authors.affiliation: Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail: orioles217@126.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.forename: Ying
authors.initials: Y
authors.lastname: Cao
authors.forename: Mengchen
authors.initials: M
authors.lastname: Zou
authors.forename: Wenxia
authors.initials: W
authors.lastname: Li
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Luo
authors.forename: Ya
authors.initials: Y
authors.lastname: Jiang
authors.forename: Yaoming
authors.initials: Y
authors.lastname: Xue
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
mesh_terms: D000900:Anti-Bacterial Agents; D000077723:Cefepime; D002511:Cephalosporins; D017719:Diabetic Foot / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D010019:Osteomyelitis / Q000382:microbiology*; D012307:Risk Factors; D014946:Wound Infection / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime