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GERMS
Volume 10
Issue 4
10.18683/germs.2020.1227
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GERMS is published by MDPI from Volume 25 Issue 4 (2025). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with the former publisher Infection Science Forum S.R.L..
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Article

Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary?

by
Angeliki M. Andrianaki
1,
Christos Koutserimpas
2,
Alexandros Kafetzakis
3,
Emmanouil Tavlas
3,
Sofia Maraki
5,
John A. Papadakis
1,
Petros Ioannou
1,*,
George Samonis
1 and
Diamantis P. Kofteridis
1
1
Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
2
Department of Orthopaedics and Traumatology, "251” Hellenic Air Force General Hospital of Athens, PC 11525, Greece
3
Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
4
Department of Microbiology, University Hospital of Heraklion, Crete, PC 71110, Greece
*
Author to whom correspondence should be addressed.
GERMS 2020, 10(4), 346-355; https://doi.org/10.18683/germs.2020.1227
Submission received: 15 September 2020 / Revised: 17 November 2020 / Accepted: 1 December 2020 / Published: 28 December 2020
Versions Notes

Abstract

Introduction: Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods: This is a prospective study conducted during a 4-year period. All patients with DFIs and/or diabetic foot osteomyelitis (DFO) admitted to the University Hospital of Heraklion, Greece, were included. Clinical data were collected, while cultures taken with swabs and/or tissue biopsies were used as indicators of the microbiological cause and the appropriate treatment. Results: In total, 83 individuals (62.7% males) with mean age of 72 years, were enrolled. Coexisting osteomyelitis was present in 18.1%. From tissue and pus cultures, 131 and 176 pathogens, respectively, were isolated. Gram-positive aerobes were the most common microorganisms, followed by Gram-negatives. Infection was polymicrobial in 40 (70.2%) out of 57 patients with tissue culture and in 54 (75.0%) out of 72 with pus culture. Microbiological results from tissue cultures were compatible with those from pus at a rate of 80%, while in cases of osteomyelitis concordance reached 100%. Multidrug-resistant organisms (MDROs) were isolated from 32 (24.4%) tissue and 44 (25%) pus cultures (p = 0.910). Initial empirical antimicrobial treatment was considered inappropriate in 44.6% of cases. Conclusions: A high concordance between easily taken swab cultures and those taken by biopsy was noted, especially in DFO. This was helpful for early change to appropriate treatment in cases where MDROs were isolated and empirical treatment was inappropriate. Further research is needed to confirm this observation in clinical practice.
Keywords: diabetic foot osteomyelitis; multidrug resistant; ulcer infections; superficial and deep tissue cultures diabetic foot osteomyelitis; multidrug resistant; ulcer infections; superficial and deep tissue cultures

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MDPI and ACS Style

Andrianaki, A.M.; Koutserimpas, C.; Kafetzakis, A.; Tavlas, E.; Maraki, S.; Papadakis, J.A.; Ioannou, P.; Samonis, G.; Kofteridis, D.P. Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary? GERMS 2020, 10, 346-355. https://doi.org/10.18683/germs.2020.1227

AMA Style

Andrianaki AM, Koutserimpas C, Kafetzakis A, Tavlas E, Maraki S, Papadakis JA, Ioannou P, Samonis G, Kofteridis DP. Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary? GERMS. 2020; 10(4):346-355. https://doi.org/10.18683/germs.2020.1227

Chicago/Turabian Style

Andrianaki, Angeliki M., Christos Koutserimpas, Alexandros Kafetzakis, Emmanouil Tavlas, Sofia Maraki, John A. Papadakis, Petros Ioannou, George Samonis, and Diamantis P. Kofteridis. 2020. "Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary?" GERMS 10, no. 4: 346-355. https://doi.org/10.18683/germs.2020.1227

APA Style

Andrianaki, A. M., Koutserimpas, C., Kafetzakis, A., Tavlas, E., Maraki, S., Papadakis, J. A., Ioannou, P., Samonis, G., & Kofteridis, D. P. (2020). Diabetic Foot Infection and Osteomyelitis. Are Deep-Tissue Cultures Necessary? GERMS, 10(4), 346-355. https://doi.org/10.18683/germs.2020.1227

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