P-216

The trend of microbial antibiotic resistance in transplant patients with the diabetic foot after 11 years

V. Fejfarová¹, A. Jirkovská¹, P. Girman¹, V. Petkov², M. Dubsk?¹, R. Bém¹, F. Saudek¹, J. Skibová^1
1 Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; ² Department of Microbiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Repeated antibiotic usage due to the higher incidence of various types of infection may lead to the extension of microbial antibiotic resistance (MAR), especially in patients with infected diabetic foot ulcers (DFU). The aim of our study was to assess the incidence of infected DFU and changes in a spectrum of found microorganisms and their MAR in all transplant patients with DFU after 11 years. Methods: All transplant patients treated for clinically infected DFU from 12/1998 to 11/1999 (group 1;n=19 of all transplant patients) and from 12/2009 to 11/2010 (group 2;n=19-6.6%) in our out-patient foot clinic were included into the study. The study groups differed significantly in the incidence of DFU (19.2%vs.6.6%;p<0.001), diabetes duration (23.5±11vs.32.5±9.7years;p<0.01) and transplantation follow-up (32.6±34.4vs.65.5±43.3 months;p<0.05). The occurrence of microbial agents, number of pathogens/1 swab and MAR of individual pathogens were compared between the study groups. Results: The occurrence of Gram negative fermentative bacteria such as E.coli, Klebsiella sp., etc. (10.5%vs.22.2%;p<0.05), non-fermentative bacteria represented by f.e. Pseudomonas sp. (6.3%vs.15.2%;p<0.05) and of S.Aureus (21.1%vs.33.3%;p<0.05) increased significantly, the occurrence of Enterococcus and Streptococcus sp. did not change and Staphylococus coagulase negative (41.1%vs.5.1%;p<0.001) significantly decreased in transplant patients with DFU after 11 years. The number of pathogens/1swab (1.3±0.7 in group 1 vs. 1.7±0.9in group 2; p<0.001) increased significantly in the group 2 compared to group 1. Higher MAR of Staphylococcus coagulase negative (p<0.01), Gram negative fermentative (p<0.001) and non-fermentative microorganisms (p<0.05) to selected antibiotics were detected in transplant patients with DFU in the second observed period. Conclusion: The incidence of infected DFU in transplant patients decreased after 11 years of follow-up at foot clinic. However, a higher number of pathogens/1 swab and higher occurrence of more resistant Gram negative microorganisms were found in such patients in their DFU after 11 years.

This study was supported by VZ MZO 00023001.

P-216

The trend of microbial antibiotic resistance in transplant patients with the diabetic foot after 11 years

V. Fejfarová¹, A. Jirkovská¹, P. Girman¹, V. Petkov², M. Dubsk?¹, R. Bém¹, F. Saudek¹, J. Skibová^1
1 Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; ² Department of Microbiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Repeated antibiotic usage due to the higher incidence of various types of infection may lead to the extension of microbial antibiotic resistance (MAR), especially in patients with infected diabetic foot ulcers (DFU). The aim of our study was to assess the incidence of infected DFU and changes in a spectrum of found microorganisms and their MAR in all transplant patients with DFU after 11 years. Methods: All transplant patients treated for clinically infected DFU from 12/1998 to 11/1999 (group 1;n=19 of all transplant patients) and from 12/2009 to 11/2010 (group 2;n=19-6.6%) in our out-patient foot clinic were included into the study. The study groups differed significantly in the incidence of DFU (19.2%vs.6.6%;p<0.001), diabetes duration (23.5±11vs.32.5±9.7years;p<0.01) and transplantation follow-up (32.6±34.4vs.65.5±43.3 months;p<0.05). The occurrence of microbial agents, number of pathogens/1 swab and MAR of individual pathogens were compared between the study groups. Results: The occurrence of Gram negative fermentative bacteria such as E.coli, Klebsiella sp., etc. (10.5%vs.22.2%;p<0.05), non-fermentative bacteria represented by f.e. Pseudomonas sp. (6.3%vs.15.2%;p<0.05) and of S.Aureus (21.1%vs.33.3%;p<0.05) increased significantly, the occurrence of Enterococcus and Streptococcus sp. did not change and Staphylococus coagulase negative (41.1%vs.5.1%;p<0.001) significantly decreased in transplant patients with DFU after 11 years. The number of pathogens/1swab (1.3±0.7 in group 1 vs. 1.7±0.9in group 2; p<0.001) increased significantly in the group 2 compared to group 1. Higher MAR of Staphylococcus coagulase negative (p<0.01), Gram negative fermentative (p<0.001) and non-fermentative microorganisms (p<0.05) to selected antibiotics were detected in transplant patients with DFU in the second observed period. Conclusion: The incidence of infected DFU in transplant patients decreased after 11 years of follow-up at foot clinic. However, a higher number of pathogens/1 swab and higher occurrence of more resistant Gram negative microorganisms were found in such patients in their DFU after 11 years.

This study was supported by VZ MZO 00023001.