Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

초록

Background In diabetic foot infection (DFI), risk of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas infection should be considered in selecting empirical antibiotics. The aim of this study is to analyze the risk factors of MRSA and Pseudomonas infection with respect to DFI in Korea to help to choose adequate empirical antibiotics. Methods This study included 737 patients with diabetic foot ulcers, who were admitted to diabetic wound center of the Korea University Guro Hospital between January 2012 and December 2016. Deep tissue or bone biopsy cultures were taken during surgical debridement in the operating room. Using eight categories of patients’ clinical characteristics (age, gender, smoking history, dialysis, HbA1c, wound duration, TcPO2, previous use of antibiotics), we evaluated the risk factors for MRSA and Pseudomonas aeruginosa infection. Results Among the 832 microbial isolates, 114 were MRSA (13.7%) and 78 were Pseudomonas (9.4%), respectively. Wound duration (>4 weeks) was the only statistically significant factor associated with the MRSA infection in univariate and multivariate logistic analysis. For Pseudomonas aeruginosa infection, three factors − gender, smoking history, and HbA1c level (<7.0%) − were found to be statistically significant in univariate analysis. In multivariate analysis, smoking history and previous treatment history emerged as strong predictors for the Pseudomonas aeruginosa infection. Conclusion Wound duration can be the risk factor of MRSA infection in diabetic foot ulcers. Regarding Pseudomonas infection, smoking history and previous treatment history can be risk factors.

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