Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot

Abstract

Infectious complications of the diabetic foot may be influenced by impaired renal function and by immunosuppression therapy. Aims: To assess differences in microbial findings and resistance to antibiotics between transplant recipients, hemodialysis patients, and other patients with the diabetic foot. Methods: 207 patients treated in the foot clinic for diabetic ulcers from 12/1998 to 12/1999 were included into this retrospective study. Patients were divided into three groups (transplant, dialysis, and other patients). Occurrence of individual bacterial species and resistance to antibiotics was compared between study groups. Results: Study groups did not differ significantly in ulcer grades defined by the Wagner classification or in the mean number of pathogens per patient. The prevalence of individual microorganisms did not differ between the study groups. However, the study groups differed significantly in the occurrence of microbial resistance to antibiotics. Transplant patients had more frequently Staphylococcus aureus resistant to oxacillin ( P<.01), imipenem ( P<.01), co-trimoxazole ( P<.01), Enterococcus species resistant to ampicillin ( P<.01), piperacillin ( P<.01), and dialysis patients had more frequently Pseudomonas species resistant to piperacillin ( P<.05) and cefpirom ( P<.05) in comparison with the other two groups. Conclusions: Transplant patients had significantly more resistant microorganisms in comparison with dialysis and other patients with the diabetic foot. Empiric antibiotic selection based on general population data should be modified in transplant patients with diabetic foot according to actual susceptibility to antibacterial drugs.