title: Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.
abstract: Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials.
  
  
  
  The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830).
  
  
  
  A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group.
  
  
  
  Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Canakkale Military Hospital, Canakkale, Turkey.
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authors.affiliation: Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Turkey.
authors.forename: Mesut
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authors.lastname: Mutluoglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, Turkey.
authors.forename: Vedat
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authors.lastname: Turhan
authors.affiliation: Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Gunalp
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authors.lastname: Uzun
authors.affiliation: Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Division of Medical Sciences, Green Templeton College, University of Oxford, Oxford, UK.
authors.forename: Benjamin A
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Sifa University Medical Faculty Izmir, Turkey.
authors.forename: Erol
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authors.lastname: Sevim
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Hayati
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authors.lastname: Demiraslan
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Esma
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authors.lastname: Eryilmaz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Eskisehir Military Hospital, Eskisehir, Turkey.
authors.forename: Cem
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authors.affiliation: Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Turkey.
authors.forename: Ali
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authors.affiliation: Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Uskudar, Turkey.
authors.forename: Hakan
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authors.lastname: Ay
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Bilgin
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Uysal
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University Medical School, Hatay, Turkey.
authors.forename: Vicdan Koksaldi
authors.initials: VK
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Bozok University School of Medicine, Yozgat, Turkey.
authors.forename: Cigdem
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authors.forename: Ayse
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey.
authors.forename: Omer
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authors.forename: Fazilet
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Sutcu Imam University, School of Medicine, Kahramanmaras, Turkey.
authors.forename: Selma
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training & Research Hospital, Ankara, Turkey.
authors.forename: Fatma Aybala
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authors.lastname: Altay
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Sakarya University School of Medicine, Sakarya, Turkey.
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authors.affiliation: Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital Ankara, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital Ankara, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyil University School of Medicine, Van, Turkey.
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authors.initials: MK
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authors.forename: Kadriye Kart
authors.initials: KK
authors.lastname: Yasar
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital Samsun, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital Samsun, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
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authors.affiliation: Department of Infectious Disease, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
authors.forename: Hamdi
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey.
authors.forename: Senol
authors.initials: S
authors.lastname: Çomoglu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
authors.forename: Affan
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authors.lastname: Denk
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey.
authors.forename: Salih
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ozlem
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authors.forename: Nazif
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authors.lastname: Elaldi
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Pamukkale University School of Medicine, Denizli, Turkey.
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authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey.
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authors.forename: Recep
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authors.forename: Emel
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mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017719:Diabetic Foot / Q000382:microbiology* / Q000503:physiopathology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D014421:Turkey; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Diabetic foot; Guideline; Infection; Turkey