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- Title
Enterococci in Diabetic Foot Infections: Prevalence, Clinical Characteristics, and Outcomes.
- Authors
Perzon, Ofer; Cahn, Avivit; Gellman, Yechiel N; Leibovitch, Michal; Peled, Shahar; Elishoov, Ofer; Haze, Amir; Olshtain-Pops, Karen; Elinav, Hila
- Abstract
Background Diabetic foot infections (DFIs) are frequently polymicrobial, yet the relevance of each isolated pathogen, remains ill-defined. Specifically, the prevalence and pathogenicity of enterococcal DFIs and the impact of targeted antienterococcal treatment remain elusive. Methods We collected demographic, clinical, and outcome-related data on patients admitted with DFIs to the Hadassah Medical Center diabetic foot unit between 2014 and 2019. The primary outcome was a composite of in-hospital death or major amputation. Secondary outcomes included any amputation, major amputation, length of stay (LOS), and 1-year major amputation or mortality rate. Results Enterococci were isolated in 35% of 537 eligible DFI case patients, who were notable for a higher prevalence of peripheral vascular disease, increased levels of C-reactive protein, and higher Wagner scores. Infection in enterococci-positive individuals was mostly polymicrobial (96.8% vs 61.0% in non–enterococci-infected patients; P <.001). Enterococci-infected patients were more likely to undergo amputation (72.3% vs 50.1%; P <.001) and had longer hospital stays (median LOS, 22.5 vs 17 days; P <.001), but the primary end point of major amputation or in-hospital death did not differ between groups (25.5% vs 21.0%; P =.26). Appropriate antienterococcal antibiotics were used in 78.1% of enterococci-infected patients and, compared with results in untreated patients, were associated with a trend toward a lower rate of major amputations (20.4% vs 34.1%; P =.06) but longer hospitalization (median LOS, 24 vs 18 days; P =.07). Conclusions Enterococci are common in DFIs and associated with higher rates of amputation and longer hospitalization. A reduction in major amputation rates with appropriate enterococci treatment is suggested retrospectively, meriting validation by future prospective studies.
- Publication
Open Forum Infectious Diseases, 2023, Vol 10, Issue 5, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofad238