Keimerhebungsprojekt des Diabetes

Keimerhebungsprojekt des Diabetes‐Fußnetz Südwest
Ergebnispräsentation 2003, 2006, 2007
Herbsttagung der ADE RLP Mainz 17.11.2009
Dr. Dirk Schulze, Pirmasens
...nur wenige Literaturangaben bei Suche nach dem Keimspektrum bei DFS Æ 1980
•
•
•
•
•
Quantitative aerobic and anaerobic bacteriology of infected diabetic feet. F L Sapico, H N Canawati, J L Witte, J Z Montgomerie, F W Wagner Jr and A N Bessman ABSTRACT
Quantitative aerobic and anaerobic cultures of deep tissue were performed on amputated infected lower limbs of 13 diabetic patients immediately after surgery. Dissection was made through intact skin distant from any preexisting ulcer. The results were compared
with those obtained from: (i) ulcer swabs (pre‐ and postamputation), (iii) curettage of the ulcer base, and (iii) needle aspiration after normal saline injection. Anaerobic transport media were used for anaerobic cultures before prompt transfer to the anaerobic chamber. A mean of 4.7 bacterial species per specimen was seen (2.3 aerobes, 2.4 anaerobes). Mean log10 growth per gram of tissue was as follows: (i) aerobes plus anaerobes = 6.99, (ii)
aerobes = 6.42, and (iii) anaerobes = 7.65. There was poor concordance between the deep tissue culture results and the results from other modalities of culture collection, though the results from other modalities of culture collection, though the results from curettage and saline aspiration were slightly better than those obtained from ulcer swabs. The most frequently isolated organisms were enterococci, anaerobic streptococci, and species of Proteus, Clostridium, and Bacteroides. When anti‐microbial therapy is indicated for this patient population, the possibility of the concomitant presence of aerobes as well as anaerobes should be considered.
J Clin Microbiol. 1980 September; 12(3): 413‐420
...Sapico et al. Æ 1984
jeweils nur geringe Fallzahlen
Rev Infect Dis. 1984 Mar‐Apr;6 Suppl 1:S171‐6.
The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features.
Sapico FL, Witte JL, Canawati HN, Montgomerie JZ, Bessman AN.
The quantitative deep‐tissue microbiology of the infected feet of 32 patients with diabetes mellitus was studied, and the clinical features of the patients were analyzed. Techniques of specimen collection designed to avoid contamination from surface flora were used to study amputated lower limbs. Cultures of deep tissue from six patients yielded only aerobes, and for one patient, only anaerobes. Cultures for 25 patients yielded a mixture of aerobes and anaerobes. A mean of 4.81 species (2.84 aerobes and 1.97 anaerobes) were isolated from each patient. The density of growth of anaerobes, however, was significantly higher than that of aerobes. Culture specimens obtained by curettage of the base of the ulcer correlated
better with results of deep‐tissue culture than did those obtained by needle aspiration or swab of the ulcers. The most frequently isolated organisms were Bacteroides species, anaerobic streptococci, group D streptococci, Clostridium species, and Proteus species. The presence of anaerobes was associated with a higher frequency of fever and foul‐smelling lesions and with the presence of a foot ulcer. Prior antibiotic therapy did not appear to influence the nature of the microorganisms isolated. The polymicrobial nature of this disease should be considered when antimicrobial therapy is indicated.
PMID: 6718934 [PubMed ‐ indexed for MEDLINE]
... bei Google Suche: Keimspektrum‐Analysen:
zahlreiche zahnmedizinische Arbeiten, nur einzelne Veröffentlichungen bei DFS
•
•
•
•
Abstract des Posters 2009 (AG Fuß RLP)
Dissertation Prien
Erhebungen Wolf,M. 2004 (AG Fuß RLP)
Reike 1999
Datenerhebung aus eigenen Daten
zertifizierter Behandlungseinrichtungen:
(Anzahl DFS‐Patienten, Anzahl infizierter Wunden)
und Daten des mikrobiologischen Labors (mit Antibiogramm) Poster der AG‐Fuß RLP: DDG‐Jahrestagung
2008 2009
Daten 2003 (Wolf, M. et al.)
8 DFS Ambulanzen / ‐ Stationen
802 Abstriche
Pseud. aer.
5%
Sonstige
13%
Staph.k.n.
11%
Enterokokke
n 15%
Staph. aur.
33%
MRSA 13%
Daten 2006
28 DFS Ambulanzen / ‐ Stationen
1893 Fälle 2161 Abstriche
Daten 2007
17 DFS Ambulanzen / ‐ Stationen
2545 Fälle 3012 Abstriche
Serratia 1%
Acinetob.2%
Enterob. 3%
Streptok. 4%
Anaerob. 2%
ESBL o.5%
Sonstige 8.5%
MSSA 29%
Proteus 4%
Klebsiella 3%
MRSA 8%
Enterok. 9%
E.coli 7%
SA k.neg.13%
Pseud. 6%
Weniger Behandlungseinrichtungen‐
aber deutliche Zunahme der Patientenzahlen und Keime!
Vergleich
2006
2161 Abstr.
28 Einrichtg.
2007
3012 Abstr. 17 Einrichtg.
Spezielle Fragestellung 2007:
Resistenzlage bei MRSA, Pseudomonas aer. und ESBL‐Bildnern
Was bedeuten für uns die Koagulase negativen Staphylokokken:
häufiger Nachweis Methicillin‐resistenter Stämme!
multimorbide Patienten bei DFS, mit Kathetern, Implantaten, Herzklappen etc.
mögliche Fragestellung für die nächsten Analysen?
Polymikrobic biofilm
Staph. epidermidis
Vielen Dank für Ihre Aufmerksamkeit!