title: The microbiology of diabetic foot infections in patients recently treated with antibiotic therapy: A prospective study from India.
abstract: OBJECTIVE
  Clinicians often treat clinically infected diabetic foot ulcers without information from cultures of the wound. The results of wound cultures may also be affected by previous antibiotic therapy. Thus, we aimed to study the microbial isolates, and antimicrobial sensitivity of previously treated patients with a clinically infected DFU.
  
  
  METHODS
  293 consecutive patients with clinically infected DFU on prior antimicrobial treatment within the immediate past few days for a duration greater than one week were evaluated for microbial etiology, antibiotic sensitivity and final outcomes. Appropriate tissue samples i.e. purulent drainage, soft-tissue and/ or bone were obtained for aerobic/anaerobic cultures and antimicrobial sensitivities. 71 patients with missing prior antibiotic data were excluded.
  
  
  RESULTS
  313 tissue samples obtained from 222 patients isolated 317 causative organisms. Most of the culture results from tissue specimens were mono-microbial (93.2%) compared to 37% in our previous cohort of 60 patients. Pseudomonas aeruginosa was the most common organism isolated on culture of bone (26.9%) or soft tissue (23.2%) specimen, respectively. Only 23% and 64% of P. aeruginosa isolates and 5.6% and 44% of Acinetobacter sp. were sensitive to quinolones and cephalosporins, respectively.
  
  
  CONCLUSIONS
  Clinically infected DFU recently treated with antibiotics have predominant monomicrobial and multi drug-resistant infection. Quinolones as an empirical antibiotic choice may not be appropriate in this setting.
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Ashu
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Suja
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Hajela
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Soham
authors.initials: S
authors.lastname: Mukherjee
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Bhadada
authors.affiliation: Department of Endocrinology, PGIMER, Chandigarh, 160012, India. Electronic address: anilbhansaliendocrine@gmail.com.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D017719:Diabetic Foot / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D007194:India; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D015363:Quinolones / Q000494:pharmacology; D014946:Wound Infection / Q000150:complications / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D015363:Quinolones
keywords: Antibiotic; Diabetes; Diabetic foot infections; Diabetic foot ulcer; Multi drug-resistant infections