Diabetic foot syndrome: importance of microbiological monitoring and antimicrobial penetration of chemotherapeutic agents into the soft tissue lower limb in determining the treatment

Abstract

Foot infections are a common and serious problem in persons with diabetes. Persistent ulcers in patients with diabetic foot syndrome in 85% of cases lead to amputation because of secondary infection and growing gangrene that significantly worsen the prognosis. The review provides the information on the spectrum of microorganisms, initiating the development of clinical and morphological forms of diabetic foot infections. Special attention has been paid to the choice in diabetic foot infections antibacterial medications based on indicators of sensitivity to them by allocated microorganisms and features of therapeutic concentrations formation in the skin, soft tissues or bone. Clinical data of researchers in the degree of penetration of various antibacterial agents in soft tissue and depend on severity lesions. In our review, it was shown that the most common pathogen was Staphylococcus aureus, followed by Pseudomonas aeruginosa, Enterobacteriaceae: E. coli, Proteus spp., Klebsiella pneumoniae, Enterobacter spp., and Acinetobacter spp. due to multidrug-resistant organisms, such as extended-spectrum betalactamase-producing Gram-negative rods or methicillin-resistant Staphylococcus aureus have emerged as substantial problem. Data on the frequency and the sensitivity of key pathogens in diabetic foot differ in Russian and foreign researchers, which causes the necessary treatment considering local peculiarities allocated pathogens and the degree of penetration of anti-infective agents in the affected tissues.