Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase-producing enterobacterales in patients with diabetic foot infections requiring hospital admission

Abstract

Purpose. Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing En-terobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to deter-mine the risk factors for these pathogens in DFIs. Material and methods. This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Mul-tivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. Results. S. aureus was the most isolated pathogen (n= 82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MR-SA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respec-tively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomy-elitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. Conclusions. MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.