The role of a gram-positive microflora and its resistance in purulent-necrotic complications in patients, suffering syndrome of diabetic foot

Abstract

Objective. To improve the results of treatment in patients, suffering diabetic foot syndrome (DFS), using conduction of the directed antibacterial therapy, taking into account the resistance of microflora revealed, and to reveal the role of a gram-positive microflora in occurrence of complications.
 Materials and methods. There were examined 1824 patients, suffering DFS for period from 2015 to 2019 yr., who suffered purulent-necrotic affections of the foot - abscess, phlegmon, purulent tendovaginitis, purulent arthritis, gangrene. All the patients suffered diabetes mellitus Type 2, average duration of which have constituted (12.3 ± 2.7) yrs. Qualitative content of microflora and sensitivity of cultures for antibiotics were revealed on automatic microbiological analizators «Vitek2» and BacT/ALERT (France).
 Results. The cause of purulent-necrotic complications was a gram-positive microflora, which in 57.1 - 66.8% patients was diagnosed in monoinfection and prevailed in a content of microbial associations. Phenomena of resistance to the main antibacterial preparations was revealed in 37.4% bacteria. The biggest resistance have had Staphylococcus aureus and Enterococcus faecalis. In 62.5% patients, owing Staphylococcus aureus, a resistance gene to Staphylococcus aureus with three genetic variations were revealed, which differed in accordance to resistance for certain groups of antibiotics. The most significant MRSA Type 3 - panresistant (in 6/2% patients).
 Conclusion. Investigations of purulent-necrotic foci in patients with the DFS witnesses, that the leading microorganism while development of complications constitutes a gram-positive microflora, which is characterized by presence of polyresistant and panresistant strains. Such a condition gives background to necessity for correcting of the antibacterial therapy administered.