• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.209-214
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• 2013

Purpose: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. Materials and Methods: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. Results: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. Conclusion: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

• Proceedings of the Korean Society of Applied Pharmacology
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• 2000.04a
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• pp.3-5
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• 2000

Of 16 million diabetic patients in the USA, 2.4 millions have experienced diabetic foot ulcer and 67,000 have amputations every year. For treatment of diabetic foot ulcer, Americans spend more than $1 billion each year, including $36,000 per patient for complete treatment and $60,000 for each amputation. Neuropathy and ischemia, two common complications of diabetes mellitus, are the primary underlying risk factors for development of diabetic foot ulcers. Ischemic ulcers develop as a result of low perfusion pressure in the foot with inadequate blood supply, whereas neuropathic ulcers develop from loss of protective sensation. In addition, diabetes also increases the risk of infection by impairing the body's ability to eliminate bacteria. From these circumstances, results are chronic wounds with impaired healing ability.

• Advances in Traditional Medicine
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• v.4 no.4
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• pp.261-266
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• 2004

Wound swabs and pus samples were collected from diabetic foot ulcers, and control pus samples from non-diabetic cases. In 144 diabetic cases screened, Pseudomonas aeruginosa was isolated from 78 cases, in which 10.59% of the isolates were multidrug resistant (MDR), whereas the 60 control cases were not MDR. The isolated bacteria were decreasingly resistant to 6 clinically administrated antimicrobics such as ceftazidime, gentamicin, ciprofloxacin, tobramycin, piperacillin and amikacin. Therefore, it is demanded that new and more effective antimicrobials of phytochemical origins are sought after. Among 11 isoflavones (YS11-YS21) isolated from Sophora and Euchresta (Leguminosae; pea plant family), 2 (YS19 and YS21) prominently exhibited the high antibacterial activity both in vitro and in vivo. By the preliminary results, the object of this paper is to evaluate the in vitro antibacterial effect of YS19 and YS21 on the clinically isolated bactera of Ps. Aeruginosa in hospitals. All the isolates were sensitive to YS19 and YS21 and for both, minimum inhibitory concentration (MIC) values ranged from $2\;to\;50\;{\mu}g/mL$. The $MIC_{90}$ values of YS19 and YS21 were $50\;{\mu}g/mL$. It is suggested that these isoflavones might consist a basis phytochemical prevention and therapy for diabetic foot infections caused by pseudomonads.

• Journal of Korean Foot and Ankle Society
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• v.25 no.2
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• pp.100-107
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• 2021

Purpose: The present study aimed to develop guidelines regarding initial choice of antibiotics for diabetic foot ulcers (DFU) by investigating bacterial isolates. Materials and Methods: This study included 223 DFU patients that visited a single tertiary hospital and underwent bacterial culture between January 2016 and February 2020. The study was conducted in two parts: 1) to compare bacterial isolates and wound healing according to comorbidities such as chronic kidney disease (CKD) and peripheral artery disease (PAD), and 2) to compare bacterial isolates according to wound depth using the Wagner classification. Results: Of the 223 patients, 43 had CKD (group A), 56 had PAD (group B), 30 had CKD and PAD (group C), and 94 had none of these comorbidities (group D). The isolation rate for multidrug-resistant gram-negative bacteria (MRGNB) and gram-negative to gram-positive bacteria ratio were highest in group C (p=0.018, p=0.038), and the proportion that achieved wound healing was lowest in group C (p<0.001). In the second part of the study, subjects were classified into 5 grades by wound depth using the Wagner classification; 13 grade I, 62 grade II, 60 grade III, 70 grade IV, and 17 grade V. No significant difference was observed between these grades in terms of isolation rates or gram-negative to gram-positive bacteria ratios. Conclusion: This study suggests antibiotics that cover gram-negative bacteria including MRGNB produces better results in the presence of CKD and PAD and that initial antibiotic choice should be based on the presence of CKD and PAD rather than wound depth.

• Journal of Microbiology and Biotechnology
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• v.26 no.2
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• pp.408-420
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• 2016

This study proposes an alternative approach for the use of chitosan silver-based dressing for the control of foot infection with multidrug-resistant bacteria. Sixty-five bacterial isolates were isolated from 40 diabetic patients. Staphylococcus aureus (37%) and Pseudomonas aeruginosa (18.5%) were the predominant isolates in the ulcer samples. Ten antibiotics were in vitro tested against diabetic foot clinical bacterial isolates. The most resistant S. aureus and P. aeruginosa isolates were then selected for further study. Three chitosan sources were tested individually for chelating silver nanoparticles. Squilla chitosan silver nanoparticles (Sq. Cs-Ag⁰) showed the maximum activity against the resistant bacteria when mixed with amikacin that showed the maximum synergetic index. This, in turn, resulted in the reduction of the amikacin MIC value by 95%. For evaluation of the effectiveness of the prepared dressing using Artemia salina as the toxicity biomarker, the LC₅₀ was found to be 549.5, 18,000, and 10,000 μg/ml for amikacin, Sq. Cs-Ag⁰, and dressing matrix, respectively. Loading the formula onto chitosan hydrogel dressing showed promising antibacterial activities, with responsive healing properties for the wounds in normal rats of those diabetic rats (polymicrobial infection). It is quite interesting to note that no emergence of any side effect on either kidney or liver biomedical functions was noticed.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.146-149
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• 2009

Purpose: Foot infections are common complications in patients with diabetes. The patients are usually immune-compromised; therefore the pathogens could be resistant to narrow spectrum antibiotics. Those drugs, however, are categorized as specially managed antibiotics, and access are difficult without confirming of the pathogens. Our aim was to analyze the common pathogens in diabetic foot infection and figure out the proper antibiotics. Materials and Methods: We studied 68 patients treated with diabetic foot infection. The pathogens which caused the infection and their sensitivity to initial antibiotics were analyzed. We also investigated the change of the antibiotics after the confirming of the culture result and average time to get the result. Results: Among the 68 patients, 56 (82%) received cephalosporin and beta-lactam antibiotics. Only 12 (18%) who were confirmed the drug resistant pathogens from previous culture, were treated with broad spectrum antibiotics such as vancomycin and tazoperan. Average culture study time was 6 days. Methicillin-resistant staphylococcus aureus (MRSA) was cultured in 19 patients (28%), Methicillin-resistant coagulase negative staphylococcus (MRCNS) in 11 patietns (17%), pseudomonas in 11 patients (17%). Total 44 (65%) including 3 of other antibiotics resistant pathogen needed broad spectrum antibiotics. Thirty two patients (47%) were resistant to initial antibiotics.irt follow up culture, 2 MRSA and 2 MRCNS were found. The antibiotics resistant pathogens were confirmed in 48 (71%) patients at last. Conclusion: Diabetic patients with foot infection need proper antibiotics from initial treatment. The proper broad spectrum antibiotics should assigned to the patients from the first time without the confirming of the culture results.

• Journal of Korean Foot and Ankle Society
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• v.13 no.2
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• pp.150-155
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• 2009

Purpose: To help the empirical antibiotics selection in diabetic foot infection patients, we investigated prevalence of microorganisms and their antibiotics sensitivity results. Materials and Methods: Patients who came to our clinics to treat diabetic foot infections with deep ulceration and were followed up more than 6 months until complete recovery were adopted. From March 2006 to June 2009, there were 140 patients who corresponded with such a inclusion criteria. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Microorganisms which was documented by wound culture and most susceptible antibiotics by minimum inhibitory concentrations were surveyed retrospectively. Results: Microorganisms were confirmed in 113 cases (80.7%). In the other 27 cases (19.3%), there were no cultured microorganisms. In bacterial growth group, there were 72 cases (63.7%) of gram-positive bacteria and 41 cases (36.3%) of gram-negative bacteria. All of them were aerobic microorganisms and there were no anaerobic microorganisms. Methicillin-sensitive staphylococcus aureus was the most common pathogen and accounted for 35 cases (31.0%). As other common pathogens, there were Enterobacter cloacae (11 cases, 9.7%), pseudomonas aeruginosa (10 cases, 8.8%), Methicillin-resistant staphylococcus aureus (10 cases, 8.8%) and enterococcus faecalis (6 cases, 5.3%), and so on. Common susceptible antibiotics in gram positive microorganism were vancomycin (60 cases, 83.3%), teicoplanin (60 cases, 83.3%), nitrofurantoin (60 cases, 83.3%) and ciprofloxacin (53 cases, 73.6%). In gram negative ones, common susceptible antibiotics were imipenem (35 cases, 85.3%), piperacillin/tazobactam (33 cases, 80.5%) and gentamicin (31 cases, 75.6%). Conclusion: Methicillin-sensitive Staphylococcus aureus in gram positive and enterobacter cloacae in gram negative was the most common pathogen in each group. Ciprofloxacin and gentamicin might be adaptable as a first-line empirical antibiotics in infected diabetic foot patients.

• Journal of Pharmacopuncture
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• v.25 no.2
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• pp.101-105
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• 2022

Objectives: This study aims to determine the Fractional Inhibitory Concentration Index (FICI) of combinations of Melastoma malabathricum leaf fraction with ciprofloxacin or gentamicin against pathogenic bacteria, Escherichia coli, Staphylococcus aureus, and Bacillus cereus, isolated from Diabetic Foot Ulcer (DFU) patients. Methods: We tested concentrations of 45%, 55%, 65%, and 75% of gentamicin and ciprofloxacin using dilution and agar diffusion methods. The combination of M. malabathricum leaf extract with these antibiotics was tested in vitro against all three bacteria. Results: The combination of M. malabathricum leaf extract and ciprofloxacin gave a FICI value of 0.5, indicating synergistic antibacterial activity against the test bacteria. Conclusion: The results show that the antibacterial effect of a combination of high doses of the leaf extract with either antibiotic is greater than that of the leaf extract and the antibiotics in single use.

• Mycobiology
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• v.45 no.3
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• pp.178-183
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• 2017

Diabetes mellitus is a chronic disorder which affects millions of population worldwide. Global estimates published in 2010 reported the world diabetic prevalence as 6.4%, affecting 285 million adults. Foot ulceration and wound infection are major forms of disabilities arising from diabetic diseases. This study was aimed to develop a natural antimicrobial finishing on medical grade textile that meets American Association of Textiles Chemists and Colorists (AATCC) standard. The textile samples were finished with the ethanolic extract of Penicillium amestolkiae elv609, an endophytic fungus isolated from Orthosiphon stamineus Benth (common name: cat's whiskers). Endophyte is defined as microorganism that reside in the living plant tissue, without causing apparent disease symptom to the host. The antimicrobial efficacy of the ethanolic extract of P. minioluteum was tested on clinical pathogens isolated from diabetic wound. The extract exhibited significant inhibitory activity against 4 bacteria and 1 yeast with the minimal inhibitory concentration ranged from 6.25 to 12.5 mg/mL. The results indicate different susceptibility levels of the test microorganism to the ethanolic extract. However, the killing activity of the extract was concentration-dependent. The finished medical textile showed excellent antimicrobial efficacy on AATCC test assays. All the microbial cultures treated with the textile sample displayed a growth reduction of 99.9% on Hoheinstein Challenge Test. The wash durability of the finished textile was found good even after 50 washes with commercial detergent. Besides, the gas chromatography mass spectrometry analysis showed that 6-octadecenoic acid and diethyl phthalate were the main bioactive constituents of the extract. In conclusion, the developed medical textile showed good antimicrobial efficacy on laboratory tests. This work can be extended to in vivo trials for developing healthcare textile products for antimicrobial applications.

• Clean Technology
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• v.29 no.2
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• pp.135-144
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• 2023

Pseudomonas aeruginosa and Staphylococcus aureus are the two most frequently encountered pathogens responsible for chronic wound infections, often coexisting in such cases. These infections exhibit heightened virulence compared to single infections, leading to unfavorable patient outcomes. The interaction among microorganisms within polymicrobial infections has been shown to exacerbate disease progression. Polymicrobial infections, prevalent in various contexts such as the respiratory tract, wounds, and diabetic foot, typically involve diverse microorganisms, with Pseudomonas aeruginosa and Staphylococcus aureus being the most commonly identified pathogens. This study aimed to compare the growth patterns of bacteria under a concentration gradient of toxic chemicals, focusing on a Gram-negative strain of Pseudomonas aeruginosa and a Gram-positive strain of Staphylococcus aureus. The minimum inhibitory concentration (MIC), which signifies the concentration at which bacterial growth is inhibited, was determined by performing broth microdilution and assessing the bacteria's growth curves. The growth curves of both Pseudomonas aeruginosa and Staphylococcus aureus were confirmed, and the exponential growth phases were applied to calculate the doubling times of bacteria. The MIC value for each toxic chemical was determined through broth microdilution. These results allowed for the identification of disparities in growth rates between Gram-positive and Gram-negative bacteria, as well as differences in resistance to individual toxic substances. We expect that this approach has a strong potential for further development towards the innovative treatment of bacteria-associated infections.