Microbiological, Clinical and Radiological Aspects of Diabetic Foot Ulcers Infected with Methicillin-Resistant and -Sensitive Staphylococcus aureus

Abstract

Diabetic foot ulcer (DFU) is one of the most common chronic complications of diabetes. This study aimed to assess the factors with an impact on the infection of diabetic foot ulcers by methicillin-resistant S. aureus and to evaluate the influence of methicillin resistance on the frequency of osteitis (based on classic X-ray images). A total of 863 patients suffering from DFU were analyzed during the study period. Out of 201 isolated S. aureus cases, 31 (15.4%) were methicillin-resistant (MRSA). MRSA infections were associated with a higher incidence of osteitis compared to MSSA infections (p << 0.0001), both the occurrence of smaller (<50%)) and greater (>50%) inflammatory bone changes (p << 0.0001). Furthermore, MRSA occurred significantly more frequently in men than in women (p < 0.01) and more often among patients with type 2 diabetes than among patients with type 1 diabetes (p < 0.05). MRSA were isolated statistically less often in overweight patients than in patients with normal BMI (p < 0.05). DFUs infected with MRSA were significantly more frequently associated with the presence of Pseudomonas sp. and other non-fermenting bacilli than those infected with MSSA (p < 0.05). To conclude, osteitis incidence is related to MRSA infection in patients with diabetic foot ulcers; thus, patients infected by S. aureus should be closely monitored in the course of using antibiotics and treated with narrow-spectrum antibiotics.