Diabetic Foot Infections: Bacteriologic Analysis

doi:10.1001/archinte.1986.00360220079017

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Vol. 146 No. 10, October 1986

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Diabetic Foot Infections

Bacteriologic Analysis

L. Joseph Wheat, MD; Stephen D. Allen, MD; Marietta Henry, MD; Clyde B. Kernek, MD; Jean A. Siders, MS; Thomas Kuebler, MD; Naomi Fineberg, PhD; James Norton, PhD

Arch Intern Med. 1986;146(10):1935-1940.

Abstract

• Diabetic patients with foot infections were prospectivelyevaluated over a two-year period. Cultures from reliable specimensavoiding contamination with foot ulcers were obtained in 54infectious episodes. Staphylococcus species, Enterococcus species,Corynebacterium species, and various species of Enterobacteriaceaewere commonly isolated. Common anaerobic isolates included Peptostreptococcusmagnus, Peptostreptococcus prevotii, and Bacteroides species.Results of cultures from 94 unreliable specimens were similar.Results of reliable and unreliable specimens obtained simultaneouslyin 26 patients agreed in seven (27%), but antibiotics selectedfor organisms isolated from unreliable specimens would haveadequately covered pathogens found in the reliable culture in24 (93%). Diabetic foot infections usually involve mixed bacterialflora, including aerobic, facultatively anaerobic, and anaerobicmicroorganisms. Specimens should be obtained from infected tissuethat does not communicate directly with the foot ulcer if possible.If such specimens are not available, cultures of purulent exudatewithin the foot ulcer or soft-tissue sinuses may provide usefulinformation on which to base decisions about antibiotic therapy.Broad-spectrum β-lactam antibiotics or a combination ofantibiotics active against facultatively anaerobic cocci andbacilli as well as anaerobes provide the best empirical antimicrobialcoverage in these patients.

(Arch Intern Med 1986;146:1935-1940)

Author Affiliations

From the Departments of Medicine (Drs Wheat and Fineberg), Pathology (Dr Allen and Ms Siders), Orthopaedic Surgery (Dr Kernek), and Medical Genetics (Dr Norton), Indiana University School of Medicine, and Metro Health (Dr Kuebler), Indianapolis; and the Department of Pathology (Dr Henry), Bishop Clarkson Memorial Hospital, Omaha.

Footnotes

Accepted for publication Jan 24, 1986.

Reprint requests to Wishard Memorial Hospital, WOP 312,1001WTenth St, Indianapolis, IN 46202 (Dr Wheat).

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